A patient's random blood sugar (RBS) level is 40 mg/dl. Immediate management is to administer?

AIIMS CRE 2025

Medical Surgical Nursing

Medium

Appeared in: AIIMS CRE 2025

Explanation

A Random Blood Sugar (RBS) of 40 mg/dL is defined as severe hypoglycemia, a life-threatening emergency.
The brain requires a constant supply of glucose; severe deficiency can lead to seizures, coma, and irreversible brain damage.
Immediate management involves rapidly raising blood glucose levels using a concentrated (hypertonic) dextrose solution administered intravenously.
25% Dextrose is a hypertonic solution that provides a rapid infusion of glucose directly into the bloodstream, making it the standard treatment for severe hypoglycemia in a clinical setting.

Option A: This is an isotonic solution and is too dilute to correct severe hypoglycemia quickly. It would require a large volume and would not raise blood sugar fast enough in an emergency.
Option C: Insulin lowers blood glucose by moving it from the blood into cells. Administering insulin to a hypoglycemic patient is strictly contraindicated and would be fatal.
Option D: Dextrose Normal Saline (DNS) contains only 5% dextrose. Like 5% dextrose alone, it is not concentrated enough for the rapid correction of severe hypoglycemia.

Visual 1: Flowchart: Management algorithm for hypoglycemia, showing different pathways for conscious vs. unconscious patients.
Visual 2: Diagram: Comparison of IV fluid tonicity (isotonic, hypotonic, hypertonic), illustrating why a hypertonic solution like 25% Dextrose is effective for rapidly increasing blood glucose concentration.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of severe hypoglycemia to guide bedside assessment, documentation, and the next nursing action.
For any patient with an altered mental status, a blood glucose check is a priority nursing action to rule out hypoglycemia, a common and reversible cause.
After administering IV dextrose, the nurse must recheck the blood glucose level within 15 minutes to confirm the effectiveness of the intervention and determine if further treatment is needed.
Patient safety is paramount. Using the wrong fluid (like insulin instead of dextrose) in this scenario would have catastrophic consequences, highlighting the need for careful checks.

How to Approach the Question

First, identify the clinical problem from the data provided: An RBS of 40 mg/dL is severe hypoglycemia.
Next, recall the goal of immediate management for this condition: to raise blood sugar levels as quickly as possible to prevent brain damage.
Evaluate each option based on its physiological effect. Ask yourself: 'Will this raise or lower blood sugar? How quickly and effectively?'
Eliminate options that are ineffective (too slow) or harmful (contraindicated). 5% Dextrose and DNS are too slow. Insulin is harmful.
Select the option that provides the most rapid and concentrated form of glucose for emergency correction, which is 25% Dextrose.

Concept Tested & Keywords

Concept Tested: Management of severe hypoglycemia
Stem keywords: random blood sugar (RBS), 40 mg/dl, immediate management
Lead-in keywords: administer
Clinical cues: RBS of 40 mg/dL indicates a medical emergency (severe hypoglycemia).
Negative lead-in flag: false

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