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PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round three
3. Capillary glucose
3b) (ii) In children with a reduced conscious level, a capillary glucose of 2.6 – 3.5 mmol/l is borderline low and the result of the laboratory glucose (requested with the core investigations) should be reviewed urgently
|
Position |
Comment |
|
Chem |
? need to define urgently ? review immediately |
|
paed |
It
needs repeating if lab glucose not
ready |
|
Endo |
- although in some areas, the
result may not be known for 2 hours and you can’t wait that long to confirm
it before treating. So although inaccurate, you have to rely on bedside test. |
|
Paed ED |
It would not be unreasonable to give some dextrose and assess response once core investigations were collected |
|
ED |
the new bedside tests [locally] will, I understand, measure down to 1.1 |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
93% |
7% |
0% |
3c) (i) In children with a reduced conscious level and a capillary glucose of 2.6 – 3.5 mmol/l, a capillary glucose should be repeated within 10 minutes, whilst awaiting the result of the laboratory glucose (to detect if the capillary glucose has fallen below 2.6mmol/l).
|
Position |
Comment |
|
Paed |
Agree broadly but I think people should use individual judgement depending on which end of the range the reading is closer to |
|
Paed |
I think these children should be given a glucose bolus |
|
Neuro s |
This is such a simple and treatable issue that I think both should be done- urgently pursue the lab result and recheck the cap glucose if there’s still no lab result within 10 minutes |
|
Chem |
Within 10 minutes is too
soon. Depends when lab glucose result
will be available. If 10-15
minutes, no need to repeat capillary glucose . If there is a delay, repeat
capillary glucose after 10-15 minutes |
|
PICU |
if remains borderline an intervention should follow –
glucose… |
|
Paed ED |
Yes, especially if decision made to wait rather than treat + assess response |
|
Neuro |
10 mins is too soon |
|
ED |
Not easy to answer – ie a lot can happen in 10 mins re further increase or decrease in GCS, which would guide further investigation. You need to qualify ie if GCS remains same or falls by 2 or more points |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
58% |
42% |
0% |
3c) (ii) In children with a reduced conscious level and a capillary glucose of 2.6 – 3.5 mmol/l, a capillary glucose should be repeated within 20 minutes, whilst awaiting the result of the laboratory glucose (to detect if the capillary glucose has fallen below 2.6mmol/l).
|
Position |
Comment |
|
Paed |
If the concern is over the accuracy of results at lower ranges better to repeat sooner ie 10 mins than later. |
|
Paed |
I think these children should be given a glucose bolus |
|
paed |
I would prefer testing at 10 minutes, to know if our resuscitation efforts are effective or not in trying to get the blood sugar up. |
|
Endo |
If it has fallen after 10 mins treatment required. What harm would it do if BG
actually 3 instead of 1 – only |
|
PICU |
too slow |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
46% |
33% |
21% |
3c) (ii) In children with a reduced conscious level and a capillary glucose of 2.6 – 3.5 mmol/l, a capillary glucose should be repeated within 30 minutes, whilst awaiting the result of the laboratory glucose (to detect if the capillary glucose has fallen below 2.6mmol/l).
|
Position |
Comment |
|
Paed |
If the concern is over the accuracy of results at lower ranges better to repeat sooner ie 10 mins than later. plus lab may be back by this time |
|
Paed |
I think these children should be given a glucose bolus |
|
Neuro s |
Surely the lab result will be back by now! |
|
metab |
Upon reflection, 10 minutes may be too soon, 30 minutes is too long |
|
chem |
but also take repeat lab glucose
at same time (unless previous lab glucose has confirmed low glucose
level) |
|
Endo |
too late in a younger child |
|
PICU |
too slow – will have intervention
in meanwhile |
|
Paed ED |
Too long if genuinely low |
|
Paed ED |
Is there any evidence for the ttime frame? The reality of it is that by the time one gets round to doing the blood glucose it will probably be 30 mins. Also the younger the child the more imperative it is to repeat. |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
39% |
26% |
35% |