Uncorrected hypoglycemia is a contraindication for both naloxone and pharmacologic management (Ketamine or Midazolam) of Combative patients.

In the hypoglycemic state, the brain does not have the substrate (energy supply) it needs to function properly, which can manifest itself in many forms; including a decreased LOA, combative behaviour and focal neurologic deficits (also why a BG < 3.0 mmol/L is a Contraindication to the Provincial Acute Stroke Bypass Protocol).

If hypoglycemia is the reason for the patient’s symptoms, naloxone will not work and midazolam may worsen the patient’s condition further. Therefore, it is the expectation, that a blood glucose will be performed prior to administration of these medications.

Should there be extenuating circumstances (patient is unstable and requires emergent intervention or too combative for safe blood glucose determination), we understand that blood glucose may be delayed until the situation safely allows for determination. But, please remember to document this!

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