Hyperglycemic emergency is defined as blood glucose greater than or equal to 11.2 mmol\L (202 mg/dL) with associated signs and symptoms, such as altered mental status, increased respiratory rate, or dehydration.

EMT Standing Order

• Routine Patient Care.
• Obtain glucose readings via glucometer.
• Call for AEMT/Paramedic intercept. & Assist AEMT/Paramedic in patient care

AEMT/Paramedic Standing Order

• Establish IV access.
• Administer 1,000 mL bolus of 0.9% NaCl IV/IO.
• Reassess lung sounds before administer an additional 1,000 mL of 0.9% normal saline or ringer lactate IV\IO if the situation prissiest
• For nausea and vomiting follow nausea and vomiting protocol.
• If the hyperglycemic patient starts to seize, maintain the patient's airway.
• Administer Diazepam 2.0 mg IV slowly or 2.0mg IM.
• Do not exceed 5.0mg without contacting medical control.
• Contact medical control for further orders.
• Transport to designated health care facility.

PEARLS:

• Diabetic ketoacidosis is a life-threatening emergency defined as uncontrolled hyperglycemia with the signs and symptoms of ketoacidosis.
• Signs and symptoms of diabetic ketoacidosis include uncontrolled blood glucose greater than 11.2 mmol\l (202 mg/dL), weakness, altered mental status, abdominal pain, nausea, and vomiting, polyuria (excessive urination) polydipsia (excessive thirst), a fruity odor on the breath (from ketones) and tachypnea.
• Common causes of diabetic ketoacidosis include infection, acute coronary syndrome and medication non-compliance.
• Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) is characterized by blood glucose levels greater than33 mmol\l (600 mg/dL) and profound dehydration with significant neurologic deficits (e.g., coma, altered mental status). Treatment is the same in the field as it is for DKA.
• Hyperglycemia may be detrimental to patients at risk for cerebral ischemia such as victims of stroke, cardiac arrest and head trauma.