Glucagon in EMS || Jack of all trades? Or just an expensive drug?
Glucagon has become one of my favorite medications 💊 since becoming an EMS provider because the indications are endless, yet so many providers only associate it with hypoglycemia. Let’s talk about this super expensive, but oh so effective medication.
Glucagon is a pancreatic hormone. The most common use of glucagon (IM) 💉in the EMS setting is for hypoglycemia, more specifically when the patient is hypoglycemic, altered and IV access is not possible. It is an extremely effective medication for this indication as it stimulates glycogenolysis (breakdown of glycogen) to temporarily increase blood sugar. But what else can it be used for?
Steakhouse 🥩 Syndrome or esophageal obstructions - Glucagon (IV) works as smooth muscle relaxer to allow the esophageal obstructions to pass (which is most commonly due to the patient not chewing their food enough).
Anaphylaxis 🫁 refractory to epinephrine - If a patient has an anaphylactic reaction and happens to take beta blockers, the epinephrine could be antagonized meaning the effects of it could be cancelled or dulled. IV glucagon is a great option in these situations. Glucagon takes a non traditional path and overrides the alpha & beta receptors due to the activation of higher cAMP levels.
Anaphylaxis 🫁 in patients unable to receive epinephrine (due advanced CAD or other medical conditions) - The above explanation is completely applicable to patients unable to receive epinephrine due to risk or danger.
Beta Blocker 🫀Overdose - Beta blocker overdoses can present with significant cardiac dysfunction and very concerning symptoms like bradycardia, hypotension, coma, etc. Large doses of glucagon (IV) is effective in these cases as the stimulation of higher cAMP levels mentioned above has positive inotropic and chronotropic effects on the heart.
Calcium Channel Blocker 🫀 Overdose - The above explanation also applies in the case of a calcium channel blocker overdoses.
And before anyone comes for me, yes, the dose required is large in these cases and most times not feasible in the 911 EMS 🚑 setting as most ambulances do not carry more than a milligram. If calcium chloride or calcium gluconate is available, it can also be considered.
Which is your favorite EMS medication?
🚨 Disclaimer: This is not meant to be used as or in the place of professional medical advice. Remember to abide by your local protocol & stay within your scope of practice. 🚨
Rukma, P. (2019). Glucagon for Refractory Anaphylaxis. American Journal of Therapeutics.
Glucagon is a pancreatic hormone. The most common use of glucagon (IM) 💉in the EMS setting is for hypoglycemia, more specifically when the patient is hypoglycemic, altered and IV access is not possible. It is an extremely effective medication for this indication as it stimulates glycogenolysis (breakdown of glycogen) to temporarily increase blood sugar. But what else can it be used for?
Steakhouse 🥩 Syndrome or esophageal obstructions - Glucagon (IV) works as smooth muscle relaxer to allow the esophageal obstructions to pass (which is most commonly due to the patient not chewing their food enough).
Anaphylaxis 🫁 refractory to epinephrine - If a patient has an anaphylactic reaction and happens to take beta blockers, the epinephrine could be antagonized meaning the effects of it could be cancelled or dulled. IV glucagon is a great option in these situations. Glucagon takes a non traditional path and overrides the alpha & beta receptors due to the activation of higher cAMP levels.
Anaphylaxis 🫁 in patients unable to receive epinephrine (due advanced CAD or other medical conditions) - The above explanation is completely applicable to patients unable to receive epinephrine due to risk or danger.
Beta Blocker 🫀Overdose - Beta blocker overdoses can present with significant cardiac dysfunction and very concerning symptoms like bradycardia, hypotension, coma, etc. Large doses of glucagon (IV) is effective in these cases as the stimulation of higher cAMP levels mentioned above has positive inotropic and chronotropic effects on the heart.
Calcium Channel Blocker 🫀 Overdose - The above explanation also applies in the case of a calcium channel blocker overdoses.
And before anyone comes for me, yes, the dose required is large in these cases and most times not feasible in the 911 EMS 🚑 setting as most ambulances do not carry more than a milligram. If calcium chloride or calcium gluconate is available, it can also be considered.
Which is your favorite EMS medication?
🚨 Disclaimer: This is not meant to be used as or in the place of professional medical advice. Remember to abide by your local protocol & stay within your scope of practice. 🚨
Rukma, P. (2019). Glucagon for Refractory Anaphylaxis. American Journal of Therapeutics.
https://sinaiem.org/foam/glucagon-for-beta-blocker-overdose/
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