Glucagon in beta blocker od

[mtmedic]

We just started carrying glucagon and I am familiar with its use in hypoglycemia but would like more info on the pathophysiology and its use in beta blocker od. Does anyone know a link or direction I could look. I will be doing some internet research as well but would appreciate any help understanding this aspect.

 

[Ridryder911]

http://www.theannals.com/cgi/content/abstract/18/5/394


I believe you will read they need to have continuous infusion of IV Glucagon.

R/r 911

 

[triemal04]

Try emedicine.com. They've got a lot of good info there on emergency medicine and non. From what I remember of glucagon in beta blockers the jury is still out on wether or not it's good; some docs say yes, and some say no. Like rid said, pretty much all agree that it takes a lot of glucagon to make a difference.

I worked an beta blocker OD awhile back, and asked the ER doc after about glucagon. His responce was worry about maintaing the pulse with atropine and pacing if neccasary and the BP with fluids, dopamine et al before anything else. That and that the 1mg we carry wouldn't be effective at all so not to worry about it.

 

[reaper]

Yes, the loading dose is 3-5mg. We only carry 2 mg's on our trucks, so that takes away that thought!:unsure:

 

[medic755]

One of the major EMS magazines (i think) had an article I was reading recently which also discussed the use of Glucagon in refractory anaphylaxis, due to the potential of pts being on B-blockers

i'm on my way to work, but here's a quick quote i found:

"glucagon plays a special role in patients who experience anaphylaxis while taking a beta-blocking agent because these patients may be unresponsive to adrenergic agents...Glucagon exerts both a positive inotropic and chronotropic effect on the heart. Its action is independent of catecholamine receptors and therefore is not affected by beta-adrenergic blockade. Thus, glucagon is considered by some to be the drug of choice for patients who have been receiving beta-adrenergic blockers. The drug is given intravenously as a bolus dose of 1 to 5 mg followed by an infusion of 5 to 15 mcg/minute, titrated against the clinical response."

 

[Ridryder911]

Although Glucagon is an excellent drug, one must be very familiar with it. True it does have properties of inotropic and chronotropic effects, it is as well a very potent smooth muscle relaxer. In fact, for those that have an esophageal obstruction (food in the esophagus), it is one of the recommended medications.

I believe the article was eluding to anaphylaxis shock specifically to those that are taking an beta blocker only. Since epinephrine may have no to little response, with the prior beta blocker. Beta blockers are great med.'s as well, but can inhibit other medications such as breathing medications (albuterol etc./not to be confused with adm of Glucagon!).

That is why understanding pharmacology as well as knowing the patient's medical history and medications is essential.

R/r 911

 

[RedZone]

Glucagon is carried here in 1 mg single dose vials (powder). 911 trucks may carry significant restock, but less active units might only carry 2mg MAX.

I am unfamiliar with its use in hypothermia.... however; larger doses (3 to 10 mg?????) are required for beta blocker reversal.

I know we don't like to think about $... but it is a factor. 1mg costs over $100. So its use is extremely expensive if you actually stock large quantities for its use as a beta blocker antidote.

Recently, I had an anti-hypertensive OD (2 meds, one was a beta blocker). We did call telemetry for permission to use glucagon, but was denied because the other med wasn't a beta blocker (I forget what it was). Instead, we gave fluids and dopamine which worked perfectly (HR was in the low 40's and BP was barely palpable < 70 systolic).

So, you do have the tools necessary to treat patients even without utilizing glucagon for these "newer" emergency properties.

 

[mtmedic]

From what I have found you are all right. We also only carry 1mg of glucagon on the trucks and the dosage for bb od wouldn't be dented by that. So for me the tx for bb od doesn't change and continues to be supportive care with whatever sx I have in front of me. I was more curious as to the actual pathophysiology behind glucagon and how it battles the bb od. I did find some info on that and the page rr911 sent was helpful as well.