IV Glucagon!??!?!?!?

[medicv83]

We have this patient in which we have all seen. The hypoglycemic, in which you've raised their sugar and it spikes ---- 156 from say 34.......Then Bammmm - back down to 32 (you've raised it with D50 yada yada yada....) So, now you admin another amp of Dextrose. Spikes again, and drops again to 36. Question is, if you could, IF your med director would allow you to do it, would you admin IV glucagon, and then, please, state why you would give it. I have my theory, which is of course, of the most miniscule of thinking, but would love to hear others approach WITH IV glucagon.

[triemal04]

No. What you're describing sounds a lot like someone who took to much insulin. The last thing they need is to dump their bodies stored glycogen. What they really need is a meal, and a supervised setting where they can be monitored for awhile.

While the bodies stores of glycogen/glucose might longer than the D50, when that's gone you don't have any options left. Get them to wake up with D50 and get some food into them.

[irme]

As above!!!

Glucagon is a backup option when IV access is likely to be delayed or impossible due to pt presentation, can you even buy glucagon as an IV option!?

[AZCEP]

This situation shows a need for nutrition in the prerequisites to EMS education.

Wake them up enough with the D50, then supervise them eating something more conducive to maintaining the elevated blood glucose level. Something with protein, and some fat in it.

[CBEMT]

My glucagon kits say "for IM or IV use."

Our protocols were recently updated to allow for glucagon administration in a suspected beta blocker-induced asystolic arrest. The way I figure, what's an IM drug going to do in a code? Not much. If the box says it's ok for IV, and the drug is indicated, why not?

[fiznat]

Only time I've ever seen IV glucagon was for beta blocker overdose, and that wasn't prehospital by any means.

[chbare]

Glucagon may also be used to decrease esophageal tone. (Spasm, foreign body, etc)

Take care,

chbare.

[Doczilla]

Glucagon can be given IV, and is for the other situations listed above (beta blocker overdose, need for inotrope in a patient with beta blockers on board, or for reducing smooth muscle spasm). It is not indicated in your clinical scenario. They need IV glucose, closely monitored blood sugars, and inpatient management. I'd put them on a D10 drip at whatever rate kept the sugars up, and check accuchecks q15 min.

When you have IV access, there is no reason to treat hypoglycemia with glucagon.

'zilla

[MSDeltaFlt]

Are they on antihypoglycemic meds? There's one in my area (on the tip of my tongue and can't remember it) that is long acting. If the pt takes too much, then their sugar drops low and stays low. D50 won't keep it up. They need admition and put on a D10 drip with frequent Accu checks until they get it out of their system and then modify the dosing regimen or change meds all together.

[firedoc5]

This situation shows a need for nutrition in the prerequisites to EMS education.

Wake them up enough with the D50, then supervise them eating something more conducive to maintaining the elevated blood glucose level. Something with protein, and some fat in it.

Man, you beat me to pretty much the same point(s) I was going to make, again. :thumbleft: