Question about Glucagon adverse reactions?

[EMT6388]

Here is my situation. I am an EMT-B and I have been going over some of the drugs in our drug kit and I have been having trouble with glucagon adverse reactions (I know that I can't give it but our advanced can so I need to know about it because I may have to call for an intercept) I don't really like memorizing a list of reactions ect. I find it much easier to remember if I know what is going on in the body to cause that reaction. For eg. with nitroglycerin one of the reactions is hypotension. That makes seance, the med dialates the vessels in the periphery, which make the pipe bigger thus lowering the pressure in it. The problem I am having is with glucagon. Everywhere I look it just lists the reactions that glucagon causes. I want to know why does it cause that. This is where I need the help from the people here. The adverse reactions that I have are 1. Hypotension 2. Tachycardia 3. Nausea and vomiting 4. Uticaria. The only one out of those 4 that make any sense is #4. a possible reaction to the med. But hypotension and tachycardia how does glucagon effect the rate and the blood pressure of the body. Plus lastly how does glucagon cause nausea and vomiting. It's a med at is used for diabetics and blood sugar. Now that I have explained my questions I do realize that I am an EMT-B (PCP trained - I'm Canadian, We did cover this drug but just briefly) so my knowledge base in not that big in the grand scheme of thing compared to a paramedic but I was hoping that I could get some help here to improve my knowledge base.

PS: I did do a search on this website so I didn't post something that had been posted already 3 times

[AZCEP]

Every drug that you will ever be exposed to will cause nausea/vomiting, so I won't spend a lot of time on that one.

For the hypotension/tachycardia, you might look at the indicated use for glucagon. Also delve into how the body will naturally respond to this indication.

Now, when the body becomes hypoglycemic, one of the first things that happens is the cardiac output will increase as a response to be able to get some food. The sympathetic nervous system is stimulated, and glucagon is released from the pancreas to use some of the stored liver glycogen.

So, with the SNS stimulation you will get tachycardia, and typically hypertension, as the body tries to provide nutrients to the brain while they are still available. The hypotension can result from the smooth muscle relaxant properties of the glucagon, but it is fairly uncommon.

[EMT6388]

Thanks for the response. That makes sense. now it will be a little biteasier to remember.

[UMSTUDENT]

Glucagon is regulated mainly by a humoral mechanism in the pancreas (low blood sugar), however, it can be stimulated by the sympathetic nervous system. Rising levels of amino acids (the base molecules of proteins) can also stimulate glucagon release. (Marieb, 2004)

Glucagon is a 29 amino-acid polypeptide (10-50 amino acids). It is traditionally made in the pancreas by pancreatic islets or islets of Langerhans (specifically alpha cells). (Marieb 44, 49)

The major target organ for Glucagon is the liver. It promotes the following actions:

1."Breakdown of glycogen to glucose (glycogenolysis)

2. "Synthesis of glucose from lactic acid and from nocarbohydrate molecules (gluconeogenesis)."

3. "Release of glucose to the blood by liver cells, which causes blood sugar levels to rise." (Marieb 630-631)

It is important to remember that blood sugar levels fluctuate and are not always a tell-tale sign of how well the body is utilizing the said monosaccharide (simple sugar).

You must remember that the amount of insulin in the blood, the number of receptors found on specific body cells, and the number and affinity (tightness and duration of bond) of the receptors are important. The amount of glucose in the body is a fluid process too since the the absorption of glucose from the small intestine is not a fixed process. The amount of cortisol in the blood is also important in this process.

Hope that helps. Wanted to reference as much as possible so you don't think I'm crazy.

Source: Marieb, E. (2004). Human anatomy and physiology. 6th ed. San Francisco, CA: Pearson Benjamin Cummings

[Doczilla]

Glucagon activates the cellular pathways that are activated by beta receptors. It essentially activates this pathway without the beta receptor, so it is a positive inotrope (increases contractility) and chronotrope (increases heart rate). For this reason, it is indicated for symptomatic beta blocker overdose. You could try dopamine/dobutamine for these folks, but since the beta blocker inhibits the receptor, they won't work very well, so glucagon is preferred.

'zilla

[NCFD18]

I live in Alabama and we do not carry glucagon. We have to start a line and push D50. As far as I know glucagon goes IM, which makes it easier then getting a line and pushing D50. But if the side effect is Nausea and Vomiting and we are giving it to a person with hypoglycemia. Lets see blood sugar is low, then you get them up and they get sick throw up alot then blood sugar goes back down. It seems kinda fubar.

[flight-lp]

Its also kinda fubar to keep the blood sugar low and not give Glucagon. N/V is a risk, but one that definately does not out weigh the benefit..............

[EMT6388]

NCFD18 we carry D50 as well, but we have glucagon as well in case we can't get a line then we go to Glucagon, D50 work much more quickly so it would make no sense to use glucagon a a first line drug. The area that we cover has a lot of older pt's and a lot of the time there veins are not the best so getting an IV is not always guaranteed. It's very rare that we use it.

[jw-c152]

to EMT:

Based on your original post ("EMT-B, but PCP-Trained" - can you explain further?) are you an EMT-B or PCP? Curious if you're PCP why you can't administer Glucagon

[EMT6388]

Sure I can explain that. I took my PCP program in Winnipeg, Manitoba but I ended up getting a full time job right away in Saskatchewan. In Saskatchewan the schools teach the PCP program as well but the government / EMS regulatory bodies have not switched from the EMT-B, EMT-I, EMT-P to the PCP, ACP, CCP designations. So my education level is PCP but my scope of practice one of an EMT-B which is almost identical to the scope of practice in Manitoba