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 defined as severe hypoglycemia, which is a medical emergency requiring immediate correction to prevent neurological damage.
• The patient is undergoing CABG, which means they are unconscious and cannot safely swallow. This contraindicates the use of oral glucose.
• Intravenous Dextrose 50% (D50) is a concentrated glucose solution that provides rapid correction of blood sugar when administered directly into the bloodstream.
• For a patient with severe hypoglycemia who is NPO or unconscious and has established IV access, IV D50 is the standard and most effective immediate treatment.

Why Other Options Were Wrong

• Option B: Normal saline (0.9% NaCl) is an isotonic fluid that does not contain glucose. It is used for hydration and electrolyte replacement but will not raise the patient's blood sugar.
• Option C: Giving oral glucose to an unconscious patient is extremely dangerous due to the high risk of aspiration, which can lead to pneumonia or acute respiratory distress.
• Option D: Insulin lowers blood glucose levels. Administering insulin to a patient who is already severely hypoglycemic would cause their blood sugar to drop even further, which could be fatal.

Related Visual

• Visual 1: Flowchart: Hypoglycemia Management Algorithm. This visual would clearly outline the decision-making process, showing separate pathways for conscious versus unconscious patients and the appropriate interventions for each (oral glucose, IV dextrose, glucagon).

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of severe hypoglycemia in a perioperative patient to guide bedside assessment, documentation, and the next nursing action.
• Perioperative glucose management is a critical nursing responsibility. Surgical stress, fasting, and anesthesia can cause significant fluctuations in blood glucose, requiring vigilant monitoring.
• Recognizing and treating hypoglycemia promptly is a crucial patient safety measure. Delay in treatment can lead to irreversible brain damage or death.
• What if the hypoglycemic patient was found unconscious at home without IV access? In that scenario, the immediate treatment would be an intramuscular (IM) injection of glucagon, as IV D50 would not be an option. Family members of diabetic patients are often trained to administer glucagon for such emergencies.

How to Approach the Question

• First, identify the key clinical data: The patient has a blood glucose of 48 mg/dL, which is severe hypoglycemia.
• Next, analyze the patient's context: The patient is 'undergoing CABG'. This tells you they are unconscious, cannot take anything orally (NPO), and will have IV access.
• Evaluate each option based on this specific context.
• Eliminate 'oral glucose' because the patient is unconscious and at risk for aspiration.
• Eliminate 'start insulin infusion' because insulin lowers blood sugar, which would be harmful.
• Eliminate 'normal IV fluids' because they do not contain glucose and won't correct the problem.

Concept Tested & Keywords

• Concept Tested: Management of severe hypoglycemia in a perioperative patient.
• Stem keywords: type 2 diabetes mellitus, 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, NPO, and have IV access.
• Clinical cues: Blood glucose of 48 mg/dL indicates severe hypoglycemia.

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Q5yE_DN6AlTM2soFouvKCw

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