Benefits and risks Criteria for starting and stopping oxygen therapy

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11. Evidence for Recommendations for Treatment of Hypoglycaemia

11.1 Sublingual administration of sugar in treatment of hypoglycaemia

Sublingual sugar may be used as an immediate irst aid measure in managing hypoglycaemia in children in situations where intravenous administration of glucose may be impossible or delayed. Strong recommendation, low quality evidence his recommendation places value on ease of use, low cost, and high availability in the absence of any serious risk, although the evidence is of low quality.

11.1.1 Evidence and summary of findings

he panel identiied two randomized controlled trials RCTs from Burkina Faso and Mali, cited in a recent review of the management of hypoglycaemia [Achoki, 2010]. Barennes et al 2005 conducted an open-label, quazi-randomized trial of intravenous glucose, sublingual sugar, and oral sugar in Burkina Faso. Children aged 6 months to 15 years presenting to the outpatient department were eligible if: 1 they had symptoms and signs of either acute respiratory infection excluding pneumonia or malaria; 2 the caregiver agreed to attend an appointment the next morning; and 3 they had a blood glucose level between 3.3 to 5 mmoll. he study screened 156 children; 87 were excluded, including 19 children initially assigned to the sublingual group, who swallowed the sugar within the irst 10 minutes. Sixty-nine were randomized to one of ive groups: 1 half a tablespoon of water n = 11; 2 IV glucose 8 mL of 30 dextrose administered in a single bolus; 3 oral glucose 2.5 g sugar; 4 single dose sublingual group 2.5 g of wet sugar under the tongue; or 5 double dose sublingual group. he main outcome was treatment failure: the proportion of children who did not reach blood glucose 5.6 during the study period. Baseline characteristics were similar across groups. here were no treatment failures in the sublingual or intravenous groups, compared with 8 53 and 9 81.8 in the oral and water groups respectively p 0.05. he approximate bioavailability was 84 for sublingual administration. he mean SD time to reach a blood glucose 5.6 was 28.5 10.6 minutes and 25.7 9.5 for the sublingual and intravenous groups, respectively. Graz et al 2008 was an open-RCT of intravenous versus sublingual sugar in children with severe malaria and hypoglycaemia in Mali. Children were eligible if