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PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round two
13. Metabolic
illness
Hypoglycaemia
13b) (iii) The emergency treatment of hypoglycaemia in a child 4 weeks old or less is an intravenous bolus of 2ml/kg of 10% dextrose.
|
Position |
Comment |
|
Neuro |
I would suggest monitoring the response very closely |
|
Renal |
Must also say “followed by infusion” |
|
PICU |
followed by IVI 10% dextrose |
|
Metab |
– hyperinsulaemia should always be thought of; & we have had such a child. |
Agreed |
Neither agree nor disagree |
Disagreed |
|
90% |
5% |
5% |
13b)(iv) The emergency treatment of hypoglycaemia in a child more than 4 weeks old is an intravenous bolus of 5ml/kg of 10% dextrose.
|
Position |
Comment |
|
Renal |
Must also say “followed by infusion” |
|
Metab |
I would still say 2ml/kg not 5, but emphasising the need for ongoing glucose 10% at normal maintenance rates |
|
Paed |
This unnecessarily complicates the process in my opinion |
|
PICU |
followed by IVI 10% dextrose |
|
Metab |
also should the case turn out to be an aspirin related Reye, theen there is a large demand for glu; that has a beneficial effect on lipolysis |
Agreed |
Neither agree nor disagree |
Disagreed |
|
87% |
9% |
4% |
Hyperammonaemia
13c (v) If the plasma ammonia remains between 200 and 500mmol/l and has not improved with the sodium benzoate infusion after 6 hours, the child should be considered for emergency haemodialysis.
|
Position |
Comment |
|
Paed |
I would hope that by this stage an expert would be helping me making this decision. Given that the statement in round one about contacting a metabolic centre for advice as soon as a plasma ammonia of > 200mmol/l was agreed and included, isn’t this statement superfluous ? |
|
Renal |
Would start sodium phenylbutyrate in addition pro tem |
|
Biochem |
micromol/l |
|
Endo |
should be discussed with metabolic specialist to consider haemodialysis |
Agreed |
Neither agree nor disagree |
Disagreed |
|
90% |
10% |
0 |
Catabolic state
13d (i) Non-hyperglycaemic ketoacidosis is present in a child with a reduced conscious level, a normal or low capillary/blood glucose, a capillary/venous pH < 7.3 and ketones in the urine.
|
Position |
Comment |
|
Endo |
Agree, although I don’t expect most paediatricians would be used to this term and would understand catabolic state more readily |
|
PICU |
seems reasonable |
Agreed |
Neither agree nor disagree |
Disagreed |
|
100% |
|
|
(iv) A child with a reduced conscious level who has non-hyperglycaemic ketoacidosis may benefit from an insulin infusion with a high dose dextrose infusion.
|
Position |
Comment |
|
Neuro |
I am not familiar with any evidence to support |
|
Paed |
Would seek expert advice, but certainly ensure correct any hypovolaemia first |
|
Metab |
Agree about the high dose glucose. Insulin only if the glucose subsequently rises above 12 mmol/l |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
67% |
22% |
11% |