IV Glucagon!??!?!?!?

[medicv83]

Sorry I didnt post a reply sooner, but was out and about all day. First, absolutely you can admin IV glucagon. This actually happened at the hospital, per the doctors orders to a pt we brought in. We initially gave, D50, OJ afterwords with some peanut butter cracker things she had for the kiddos. Then enroute, her sugar dropped again, and we gave a second amp of D50. At the hospital, doc admined another amp of D50 after her sugar dropped from out second dose, and he also ordered IV Glucagon...His rationale was that it blocked the liver from storing glycogen, or in any case, the conversion from glucose to glycogen, to keep max amount of dextrose in the blood available for metabolism.

[fallout]

I am curious about rates on dextrose drips. I work for a service that still cares D5 and I routinely hang D5 on patients whose blood sugar I am fighting the increase and drop battle on. We don't have a protocol for that, but it seems logical.

[saboats]

The reason you can give glucogon in a BB OD is Glucagon converts ADP to cAMP by increasing the activity of the enzyme adenocyclase (which is what converts ADP to cAMP) the cAMP then binds to a receptor on the Ca++ channel allowing some ca++ in, this Ca++ binds to the sarcoplasmic reticulum causing the sarcoplasmic reticulum to release lots of

stores of Ca++ which will increase myocardial contractility and rate, thus

reversing the effects of the beta blockade. However it takes a lot to due this. Starting does of 5mg IV is normal, with repeated doses. Most EMS agencies do not carry enough for this to be effective. Ca++ Chloride also would work in moderate doses for this reason, CA++ Glucanate is better if it's an option.

[AZCEP]

Calcium is not going to help manage a beta blocker OD. The calcium channels are closed due to the beta blocker, and adding more will not change that.

Calcium chloride is the preferred preparation for critical patients as it has roughly three times as much ionized calcium available when compared to calcium gluconate.

[logos]

Calcium is not going to help manage a beta blocker OD. The calcium channels are closed due to the beta blocker, and adding more will not change that.

Calcium chloride is the preferred preparation for critical patients as it has roughly three times as much ionized calcium available when compared to calcium gluconate.

I would try not to think of ion channels as discretely open or closed. Better to think of it as a whole class of receptors spending a greater percentage of their time in a closed state. Sort of a lower probability of opening state. One way to force them more towards the open state is to alter the gradient of the relevant ion across the channel. Thats the idea behind giving calcium, although it seems it is not considered standard of care in the absence of a specific indication, it is theoretically possible that it would be efficacious.

The mechanism of change in the relevant calcium channel permeability is allosteric change secondary to the binding of cAMP to cyclic nucleotide gated ion channels. Therefore change is dependant on the concentration of cAMP within the cell, which is affected by a number of trans acting factors (beta agonists, glucagon, and an large cadre of others). The state of these channels will therefore depend not only on the degree of depth of the adrenergic blockaide, but on a number of other factors.

The point is, it's better to think of the function of proteins as a continuum rather than an on-off situation.

[Scaramedic]

All the medicine and physiology aside there is a reason you do not see a lot of Glucagon use in EMS, the cost. It runs about $100 a kit.

Take our protocols for Calcium Channel Blocker and Beta Blocker overdoses. If the patient is Bradycardic we give 5mg Glucagon as well as Atropine, CaCl[sub:e1cb048b3b]2[/sub:e1cb048b3b], and Dopamine or an Epi drip.

That is over $500 worth of Glucagon!! With Medicare capitating ALS transport at what $400, you can see why many places do not like the use of Glucagon. It is actually the most expensive drug we carry.

[CBEMT]

All the medicine and physiology aside there is a reason you do not see a lot of Glucagon use in EMS, the cost. It runs about $100 a kit.

Take our protocols for Calcium Channel Blocker and Beta Blocker overdoses. If the patient is Bradycardic we give 5mg Glucagon as well as Atropine, CaCl[sub:5a0c2e4a72]2[/sub:5a0c2e4a72], and Dopamine or an Epi drip.

That is over $500 worth of Glucagon!! With Medicare capitating ALS transport at what $400, you can see why many places do not like the use of Glucagon. It is actually the most expensive drug we carry.

Fortunately for us, the ER has to restock anything we use- so we'd be getting all that Glucagon back for free. Buy a med once, and only have to worry about it if you don't transport. If you know where to go you can even get your soon-expiring doses exchanged. I love it.

That said, we only carry 2mg of Glucagon. One in the house bag, the other in the drug box.

[Doczilla]

They may not have all that much to restock. I started a patient on a glucagon drip, and got a nervous phone call from the pharmacy since I used up the entire hospital's supply in one bag for about 10 hours' worth.

'zilla

[Scaramedic]

They may not have all that much to restock. I started a patient on a glucagon drip, and got a nervous phone call from the pharmacy since I used up the entire hospital's supply in one bag for about 10 hours' worth.

'zilla

$$$$$$$$$$$$$$$

[Dustdevil]

They may not have all that much to restock. I started a patient on a glucagon drip, and got a nervous phone call from the pharmacy since I used up the entire hospital's supply in one bag for about 10 hours' worth.

You sure that wasn't the CFO calling?