Whenever possible, if the clinical condition allows, children should be treated with oral glucose loading. Clearly this should not occur in children unable to protect their airways. Common methods include orange juice with 2 tsp of sugar added per glass, maple syrup, honey (in older children), and, in mild cases, nondiet soda. Sucrose and fructose should not be given to any child suspected of having hereditary fructose intolerance. Lactose should not be given to children suspected of having galactosemia. Once the glucose concentration is back to the normal range, these children should be given a meal containing complex carbohydrates, proteins, and fats. This is presuming that inborn errors of metabolism have been ruled out.

When oral treatment is not an option, the intravenous route should be used ( Table 125-4). Boluses of 0.25 to 0.5 g/kg are most commonly used. This is equivalent to

2.5 to 5 mL/kg 10% D/W, 1 to 2 mL/kg 25% D/W, or 0.5 to l mL/kg 50% D/W. If no response is seen within 5 min, this should be repeated and a bedside glucose checked. If the glucose remains <50 mg/dL and three boluses have been given, the clinician should consider using one of the alternative agents listed below. The proper choice should be based upon the clinical and historical findings.

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