Glucagon therapy in hypoglycemia - Tips From Other Journals

Date: August, 1991

Treatment of patients with altered mental status caused by hypoglycemia may be complicated by patient agitation and difficult intravenous access. The efficacy of glucagon has been established in patients refractory to exogenous dextrose. Vukmir and colleagues conducted a prospective clinical trial to evaluate the efficacy of glucagon in the prehospital treatment of hypoglycemic patients in whom intravenous access could not be obtained.

The study included 50 patients with hypoglycemia (blood glucose of 80 mg per dL [4.4 mmol per L] or less as determined by blood glucose test strip) and symptoms of decreased level of consciousness, syncope or seizure. All of the patients were evaluated by paramedics and were determined to have difficult intravenous line access. The patients ranged in age f rom four months to 97 years (mean age: 56.8 years). A history of diabetes was reported in 62 percent of the patients. Glucagon was administered in 1.0-mg doses in adults and 0.5-mg doses in children by intramuscular or subcutaneous routes. Pretreatment and post-treatment levels of serum glucose were measured. The level of consciousness of each patient was assessed by a quantitative measure (the Glasgow Coma Scale) and by a qualitative scale (3 = alert; 2 = responsive to verbal stimuli; 1 = responsive to painful stimuli; 0 = unresponsive).

Mean serum glucose levels were 33.2 mg per dL (1.8 mmol per L) before treatment and increased to 133.3 mg per dL (7.4 mmol per L) after treatment. Mean qualitative level of consciousness scores increased from 1.26 before treatment to 2.42 after treatment, and mean Glasgow Coma Scale scores increased from 9.00 before treatment to 13.04 after treatment. In the 41 patients (82 percent) who had increases in both of the scores, mean time until response was 8.8 minutes. Administration of glucagon resulted in an increase in glucose levels in 49 (98 percent) of the patients. Headache was reported in only two patients (4 percent).

The authors conclude that glucagon is safe and effective therapy in the management of hypoglycemia in the prehospital setting. Glucagon has a rapid onset of action with minimal side effects, and the deleterious effects of hyperglycemia are avoided. Annals of Emergency Medicine, April 1991, vol. 20, p. 375.)

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