This protocol addresses adult patients with Ebola virus disease (EVD) who develop symptomatic hypoglycaemia — defined as a blood glucose below 54 mg/dl (below 3 mmol/l) — accompanied by altered mentation or seizure. This combination represents an acute metabolic emergency requiring immediate action.
Adult EVD patients presenting with evidence of symptomatic hypoglycaemia and altered mentation or seizure. Hypoglycaemia in this context is defined as a glucose level below 3 mmol/l or below 54 mg/dl.
Management centres on emergent blood glucose correction using dextrose, followed by a maintenance strategy to sustain stable glucose levels. The target is to restore blood glucose above 80 mg/dl, with glucose re-checked 15 minutes after initial treatment.
Blood glucose > 80 mg/dl; glucose re-checked 15 minutes after initial treatment, with ongoing monitoring until stable.
For adult patients with evidence of symptomatic hypoglycaemia and altered mentation or seizure:
Hypoglycaemia is defined as < 3 mmol/l or < 54 mg/dl in adults and children in the context of EVD.
Emergent treatment with one ampoule D50 (25 g) and re-check glucose in 15 minutes. A second ampoule of glucose may be required within 1 hour of treatment.
Add 50 g of dextrose (100 ml of D50) to 900 ml of 0.9% saline or Ringer's lactate as maintenance fluid; or use D10W at 50 ml/hour to correct glucose in a 60 kg adult.
Adjust rate sufficiently to maintain blood glucose > 80 mg/dl, with hourly glucose checks until four stable glucose levels, after which glucose monitoring can be decreased in frequency to every 4 hours.
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