Parenteral Manual

Glucagon

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Pancreatic polypeptide
Classification: 
Hyperglycemic agent
Original Date: 
August 2005
Revised Date: 
March 2013
Indications: 
  • Counteracts severe hypoglycemic reactions in diabetic patients; only useful if liver glycogen stores are normal
  • Adjunct in the treatment of refractory heart failure
  • Anaphylaxis in the emergency department
Reconstitution and Stability: 
  • Stable at room temperature
  • Reconstitute with diluent provided for a 1 mg/mL solution
  • Reconstituted solution stable 48 hours refrigerated
  • For continuous IV infusions, reconstitute vial with 1 mL D5W or D10W (NOT diluent provided); shake well to dissolve.  Further dilute with D5W or D10W.  This solution is stable 24 hours
Compatibility: 

- Solutions Compatible: D5W, D10W

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

- Incompatible: NS, DO NOT mix with any other drugs

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES
IM YES
IV Direct YES
Usual dilution: 1 mg/mL   
Infusion time: 1 minute
IV Intermittent Infusion NO
IV Continuous Infusion YES
Usual dilution: 0.04 mg/mL
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:      

  • <20 kg: 0.02-0.03 mg/kg/dose SC/IM/IV (Maximum: 1 mg/dose)
  • >20 kg: 0.5 - 1 mg SC/IM/IV
  • May repeat in 20 minutes

- Continuous IV Infusion:              

  • 0.2 mcg/kg/hr (usual maximum:  1 mg/day)
  • Dose is titrated to maintain blood glucose at a level determined by the physician (usually 3-4 mmol/L)
  • Indicated for endogenous hyperinsulinism or resistant hypoglycemia

- Anaphylaxis in the emergency department

  • 20 - 30 mcg/kg/dose, MAX 1 mg IV over 5 min x 1 dose followed by
    IV infusion of 5 - 15 mcg/min - titrated to clinical effect
    (consider use in patients who remain hypotensive despite multiple doses of epinephrine, patients on beta blockers, pregnant adolescents and in patients with sodium metabisulfite allergy

Adolescent/Adult:              

  • 0.5-1 mg SC/IM/IV
  • May repeat in 20 minutes  

 

Potential hazards of parenteral administration: 
  • Hypotension - especially with large doses
  • Hypersensitivity reactions (rash, urticaria, rarely hypotension or anaphylaxis)                           
  • Hyperglycemia due to excessive dosage
  • Hypokalemia
  • Nausea and vomiting
Notes: 
  • Monitor BP and blood glucose
  • 1 unit of glucagon = 1 mg glucagon                                           
  • Patient should respond in 10-20 minutes    
  • Do not delay initiation of glucose infusion while awaiting the effects of glucagon  
  • Upon responding from coma, the patient should be given oral carbohydrates
  • Discontinue infusions gradually to avoid rebound hypoglycemia
  • Bolus glucagon in idiopathic hyperinsulinism produces rebound hyperglycemia

 

References: 

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