Glucagon

Indications:

• Hypoglycemia when no IV is obtainable and gag reflex is absent (NOT a first-line choice for hypoglycemia); hypoglycemia defined as POC glucose analysis:
• Adult: less than 80 mg/dL (non-diabetic), or less than 110 mg/dL or symptomatic (diabetic)
• Pediatric: less than 70 mg/dL (non-diabetic), or less than 70 mg/dL or symptomatic (diabetic)
• Beta blocker and calcium channel blocker toxicity

Contraindications: Hypersensitivity to proteins

Precautions:

Administer cautiously to:

• Patients with cardiovascular disease
• Patients with kidney or liver dysfunction

Side Effects:

• Hypotension
• Nausea and vomiting
• Tachycardia

Adult Dose:

Hypoglycemia:

• 1 mg IV/IO/IM/IN/SQ - standing order
• If no response, BioTel may authorize an additional dose at 20-minute intervals, if necessary

Bradycardia (beta-blocker toxicity):

• 1 mg – 2 mg IV/IO - standing order
• 1 mg IM/IN if IV or IO access not available

Cardiac arrest (beta-blocker toxicity):

• 1 mg – 2 mg IV/IO push - standing order, may repeat once.

Pediatric Dose 1 to 13 years of age:

Standing order:
Hypoglycemia:

• 1 mg IV/IO/IM/IN/SQ - standing order; may repeat once after 20 minutes.
• If no response, BioTel may authorize an additional dose.

Beta-blocker toxicity:

• 1mg IV/IO – BioTel may authorize an additional dose at 20-minute intervals.
  

Pediatric Dose Under 1 year of age:

Standing order:
   Hypoglycemia:

• 0.5 mg IV/IO/IM/IN/SQ - standing order; may repeat once after 20 minutes.
• If no response, BioTel may authorize an additional dose.

Beta-blocker toxicity:

• 0.5 mg IV/IO – BioTel may authorize additional doses at 20-minute intervals.

Route:

• IM  or SQ for hypoglycemia
• IM or slow IV push (over 2-5 minutes): bradycardia due to beta-blocker or calcium-channel blocker toxicity
• Rapid IV/IO push: cardiac arrest due to beta-blocker or calcium-channel toxicity
• Intranasal (IN) as an alternative route when other routes are inaccessible

Drug Action:

• Converts stored glycogen to glucose, increasing blood glucose level
• Improves cardiac contractility and increases heart rate

Class: Pancreatic Hormone;  Insulin Antagonist

Onset: Within 1 minute - however it may be 15 minutes before any response is observed

Duration: 60 - 90 minutes