If the patient is alert and able to take orally:

• Give 3 vials of 25% dextrose orally.
  
  

• Recheck random blood sugar (RBS) after 15 minutes.
  
  

• If still hypoglycemic, repeat 3 vials.
  
  

• Provide complex carbohydrates to prevent recurrence:
  
  

  • Examples: chicken sandwich, ice cream.

If the patient is unable to take orally:

• Administer 2 mL/kg of 25% dextrose IV/IO.
  
  

• If IV/IO access is not possible, give:
  
  

  • IM glucagon:
    
    

    • 1 mg if >25 kg
      
      

    • 0.5 mg if <25 kg
      
      

• Start maintenance fluids to prevent recurrence:
  
  

  • Adults: D5W at 75–100 mL/hour
    
    

  • Children: D10NS at 1.5× maintenance rate
    
    

• If hypoglycemia persists:
  
  

  • Give IV hydrocortisone.

• Medications:
  
  

  • Insulin, sulfonylureas, other diabetic drugs
    
    

  • Quinolones, pentamidine, quinine
    
    

  • Non-selective beta-blockers, ACE inhibitors
    
    

  • Haloperidol, doxepin, fluoxetine
    
    

  • Lithium, NSAIDs (especially indomethacin)

• Metabolic/Nutritional:
  
  

  • Missed meals, fasting, anorexia nervosa
    
    

  • Malnutrition, alcohol ingestion

• Infections/Endocrine:
  
  

  • Sepsis, adrenal insufficiency, malaria
    
    

• Organ Dysfunction:
  
  

  • Renal failure, hepatic failure, cardiac failure

• Other:
  
  

  • Endogenous hyperinsulinism (e.g., insulinoma)
    
    

  • Post-gastric bypass
    
    

  • Myxedema coma
    
    

  • Pregnancy/lactation
    
    

  • Strenuous exercise