Treatment | Altered Level Conciousness

<< Altered Level of Consciousness: Evidence-Based Management in the Emergency Department (Pharmacology CME)


General Treatment Strategies

Early treatment steps in the patient with ALOC should include providing supplemental oxygen. Hypoxemia can be both a primary or secondary mechanism involved in a patient’s altered presentation, and supplemental oxygen should be given as needed, especially if the pulse oximetry reading is low or if the patient is hypoventilating. The empiric administration of dextrose should be considered in the patient with ALOC, especially if the patient is a neonate. Hypoglycemia can be addressed by administering 0.25 g/kg of dextrose as a resuscitative dose. This is equivalent to 2.5 mL per kg of 10% dextrose, although providers can give as much as 4 to 5 mL per kg of 10% dextrose fluid intravenously every 5 to 10 minutes as needed.7,32 Following this, a goal glucose infusion rate of 6 to 8 mg/kg/min can be used to maintain euglycemia.Usually, 10% dextrose fluid at 1.5 times maintenance rate achieves an adequate glucose infusion rate.7,32 Plasma glucose checks should be completed frequently until a stable level > 70 mg/dL is attained more than once.32

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