What is the first-line treatment for a patient with severe hypoglycemia who is unconscious?

• A. Administer intravenous dextrose (D50) or intramuscular glucagon as per protocol.
• B. Oral glucose.
• C. Intravenous saline without glucose.
• D. Observe and reassess later.

Answer: (A)

Restoring brain fuel quickly is the key for unconscious patients with severe hypoglycemia. When someone is unconscious, they cannot safely take oral glucose, and time is critical to prevent brain injury. The fastest, most reliable first-line treatment is intravenous dextrose—typically 25 g of 50% dextrose given IV—which raises blood glucose within minutes and can quickly restore consciousness. If IV access isn’t available or reliable, intramuscular glucagon (usually 1 mg in adults) is an alternative that prompts the liver to release glucose into the bloodstream, providing a rapid but shorter-acting boost. Administering intravenous saline without glucose won’t correct the low blood sugar, and simply observing or reassessing later delays necessary treatment. So, promptly giving IV dextrose or IM glucagon per protocol is the best first step.