What is the immediate management for severe hypoglycemia with altered mental status?

• A. 50% dextrose IV or intramuscular/Subcutaneous glucagon if no IV access.
• B. Oral glucose tablets only.
• C. IV saline without dextrose.
• D. Observation without treatment.

Answer: (A)

When severe hypoglycemia leads to altered mental status, the brain must be granted glucose as quickly as possible to prevent brain injury. The best immediate management is to administer 50% dextrose intravenously to rapidly raise blood glucose. If IV access isn’t available, giving glucagon intramuscularly or subcutaneously is the next fastest option to mobilize hepatic glucose stores. Oral glucose tablets aren’t suitable here because the patient cannot reliably swallow and the onset is slower, risking further cerebral impairment, and IV saline without dextrose provides no glucose. Observation without treatment is unsafe in this scenario. After glucose is restored and the patient is awake, transition to a safe, longer-term plan for glucose management.