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 10 mL\kg bolus of 0.9% NaCl IV/IO . Reassess and a
• Contact online Medical Direction for additional fluid bolus orders.
• Oral fluids: if the patient is not vomiting, provide oral hydration with water.
• Patient must be alert enough to swallow and protect the airway.
• Use 10 mL/kg fluid bolus to avoid the potential risk of cerebral edema.

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 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 than (33 mmol/dl) 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.