How does hypoglycemia cause seizures and how is it managed acutely?

• A. High glucose triggers seizures and should be treated with insulin.
• B. Low glucose deprives neurons of energy leading to electrical instability; treat with fast-acting oral glucose or IV dextrose 50%.
• C. Electrolyte imbalance is the only cause, treat with saline.
• D. Seizures during hypoglycemia are unrelated to glucose.

Answer: (B)

Low glucose deprives brain cells of the energy they need to maintain ion balance and normal electrical activity. When ATP production falls, the Na+/K+ pumps struggle, neurons become unstable, and abnormal electrical firing can trigger a seizure. The quickest way to stop this process is to restore glucose right away.

If the person can safely swallow, give fast-acting carbohydrates such as glucose tablets or juice to raise blood sugar quickly. If IV access is available, give a bolus of IV dextrose 50% (usually 25 g, which is 50 mL of D50W). If the person is unconscious or cannot swallow, administer glucagon if IV access isn’t available, then secure IV access and start dextrose once it’s feasible. After stabilization, transition to longer-term management with oral carbohydrates and adjust diabetes treatment to prevent recurrence.

This approach directly addresses the energy deficit causing the seizure, whereas the other ideas don’t reflect the relationship between low glucose and neuronal excitability or the correct acute treatment.