A patient with type 2 diabetes mellitus and hypertension undergoing CABG is found to have a blood glucose level of 48 mg/dL. What is the most appropriate immediate treatment?

1. A

   Provide Dextrose 50% (D50) IV

2. B

   Administer normal IV fluids

3. C

   Give oral glucose

4. D

   Start insulin infusion

Appeared in: NORCET 10 Prelims-2026

Explanation

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• A blood glucose level of 48 mg/dL is classified as severe hypoglycemia, which requires immediate medical intervention to prevent neurological damage.
• The patient is undergoing CABG, which means they are unconscious and unable to take anything by mouth, making oral treatments unsafe.
• The standard protocol for severe hypoglycemia in a patient with existing IV access is the rapid administration of intravenous dextrose.
• 50% Dextrose (D50) provides a concentrated, fast-acting source of glucose directly into the bloodstream to quickly raise blood sugar levels.

Why Other Options Were Wrong

• Option B: Normal IV fluids, such as 0.9% Normal Saline, do not contain glucose. They are used for hydration or as a vehicle for other medications but will not raise the patient's blood sugar.
• Option C: Administering anything orally to an unconscious patient is strictly contraindicated due to the high risk of aspiration, which can lead to aspiration pneumonia and other severe respiratory complications.
• Option D: Insulin's primary function is to lower blood glucose levels. Administering insulin to a patient who is already severely hypoglycemic would cause a further, life-threatening drop in blood sugar, potentially leading to coma, seizures, or death.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of severe hypoglycemia in an unconscious patient to guide bedside assessment, documentation, and the next nursing action.
• Recognizing and treating hypoglycemia is a critical nursing skill, especially in perioperative settings where patients are NPO and under anesthesia.
• Nurses must be vigilant in monitoring blood glucose levels for diabetic patients undergoing surgery, as stress and altered intake can cause significant fluctuations.
• The 'Rule of 15' (give 15g of carbs, wait 15 minutes, recheck glucose) is a standard protocol for conscious patients but is inappropriate for unconscious patients where IV intervention is required.

How to Approach the Question

• First, identify the critical information in the clinical scenario: the patient has a blood glucose of 48 mg/dL.
• Recognize that a glucose level below 70 mg/dL is hypoglycemia, and 48 mg/dL is severe.
• Next, analyze the patient's condition and setting: the patient is 'undergoing CABG'. This is a key clue that the patient is unconscious, under anesthesia, and cannot swallow.
• Evaluate each treatment option based on this context.
• Eliminate 'Give oral glucose' because of the aspiration risk in an unconscious patient.
• Eliminate 'Start insulin infusion' as insulin lowers blood glucose and would be fatal in this situation.

Concept Tested & Keywords

• Concept Tested: Management of severe hypoglycemia in an unconscious patient.
• Stem keywords: type 2 diabetes mellitus, hypertension, CABG, blood glucose level, 48 mg/dL
• Lead-in keywords: most appropriate immediate treatment
• Clinical cues: Patient is undergoing CABG, which implies they are unconscious and NPO (nothing by mouth).
• Clinical cues: Blood glucose of 48 mg/dL indicates severe hypoglycemia, a medical emergency.

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Reference Book

E6 Pharmacology Nursing Lilley 11e Part 2 p. 210-212

E6 Medicine Davidson Principles Practice 24e p. 761-763

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1342-1344