In a pediatric patient with hypoglycemia when IV access cannot be established, what is the glucagon dose and how is it given?

• A. 0.5 mg nebulized
• B. 0.03 mg/kg IM/IN; may be repeated after 20 minutes for a combined maximum dose of 1 mg
• C. 0.03 mg/kg IV/IO
• D. 1 mg IM/SC/IN

Answer: (B)

The main idea is how to dose glucagon in a child when you don’t have IV access. Glucagon is given by intramuscular injection or intranasal spray at a weight-based dose of 0.03 mg per kilogram, with a maximum single dose of 1 mg. If the child doesn’t respond within about 20 minutes, you may repeat the same dose, but the total amount given should not exceed 1 mg.

This approach ensures the dose is appropriate for the child’s size, while a single 1 mg cap protects against overdosing when larger amounts aren’t necessary or when to repeat doses. Nebulized dosing isn’t the standard practice here, and intravenous/IO administration isn’t an option when IV access cannot be established. A flat 1 mg dose for every child doesn’t account for weight, which is why the weight-based rule is preferred.