What is the appropriate intervention for a child with hypoglycemia presenting with altered mental status?

For a child presenting with hypoglycemia and altered mental status, the most appropriate intervention is to administer oral glucose or intravenous dextrose if the child is unable to swallow. This is vital because hypoglycemia can rapidly lead to significant neurological compromise and potential loss of consciousness if left untreated. The prompt administration of glucose directly addresses the low blood sugar levels, quickly providing the brain with the energy it needs to function properly.

In cases where the child is conscious and able to swallow, administering oral glucose can effectively normalize blood sugar levels. However, if the child is unable to swallow due to altered mental status, intravenous dextrose is the safest option, ensuring that the child receives the necessary glucose without the risk of aspiration associated with oral administration.

The other options are less appropriate in this scenario. Giving water and waiting for improvement does not directly address the immediate need for glucose and could prolong the child's hypoglycemic state. Administering insulin would only exacerbate hypoglycemia, as it facilitates the uptake of glucose into cells, further lowering blood sugar levels. Providing a high-protein snack is also not suitable for an acutely hypoglycemic child, especially one with altered mental status, as it does not provide immediate glucose that the brain requires.