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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

GLUCAGON

Indication

  • the primary use of glucagon is for the treatment of hypoglycemia which is unresponsive to routine management

Pharmacology

  • glucagon is a single chain protein of 29 amino acids, which is normally produced by the alpha cells of the pancreas
  • glucagon increases hepatic glucose production by stimulating both glycogen breakdown and gluconeogenesis; these effects are mainly due to activation of adenylate cyclase which produces increased cyclic AMP
  • parenteral administration of glucagon also produces smooth muscle relaxation in the stomach, and large and small bowel
  • the effects on blood glucose levels occur within 5-20 minutes after parenteral administration and last for 60-90 minutes
  • decreased response with repeated doses

Side Effects

  • hypersensitivity (reactions include urticaria, respiratory distress and hypotension), vomiting, hypokalemia

Precautions

  • do not wait for glucagon to increase blood glucose levels; glucose infusion should be running
  • glucagon is incompatible with electrolyte-containing solutions; therefore, do not administer with solutions which contain NaCl or KCl

Dose

  • 0.025 to 0.3 mg/kg SC, IM or IV; maximum 1 mg/dose
  • may repeat every 20 to 30 minutes prn
  • glucagon has been administered as a continuous infusion (0.5 mg/day) in SGA infants to treat hypoglycemia(87)
  • a continuous infusion rate of 0.01 to 0.1 mg/kg/h has also been recommended(27)

Supplied

  • to 1 mg vial of lyophilized powder, add 1 mL of sterile water for injection; the concentration of the reconstituted solution is 1 mg/mL(88)
  • note that 1 mg = 1 unit
  • pharmacy to supply continuous infusions as standard concentrations:
    • for patients less than 2kg: 0.1mg/mL supplied as 2.5mg in 25mL total volume of IV fluid
    • for patients over 2kg: 0.2mg/mL supplied as 5mg in 25mL total volume of IV fluid
  • glucagon, when diluted further for a continuous infusion, is stable for 24 h at room temperature(89)

References

  1. Fanaroff AA and Martin RJ (eds): Neonatal-Perinatal Medicine, Mosley, Toronto, 1992.
  2. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  3. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.
  4. Carter PE, Lloyd DJ and Duffy P: Glucagon for hypoglycemia in infants small for gestational age, Arch Dis Child, 1988; 63: 1264-1266.
  5. "Glucagon" Package Insert, Eli Lilly Canada Inc.
  6. Personal Communication, Eli Lilly Canada Inc, 25 March 1992.



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