Patient has a glucose of 28 mg/dL and IV access cannot be established; what is the next best drug to administer?

• A. Glucagon
• B. Dextrose 50% IV
• C. Epinephrine
• D. Normal saline

Answer: (A)

When IV access isn’t available, treat life-threatening hypoglycemia with glucagon given by intramuscular injection. Glucagon works by prompting the liver to release stored glucose (glycogenolysis and gluconeogenesis), so blood glucose rises within about 10–20 minutes after a dose. For adults, the typical dose is 1 mg IM, and a second dose can be given after about 15 minutes if there’s no adequate response.

Dextrose 50% IV would correct hypoglycemia more quickly, but that requires an IV line. Epinephrine and normal saline do not directly raise blood glucose to correct the hypoglycemia in this situation. After glucagon is administered, you should attempt to obtain IV or IO access and continue management, monitoring glucose closely and transporting the patient as needed.