Dose: 30 mcg/kg/dose (300 mcg/kg/dose for IDM) IV, IM, or SubQ

Frequency: Q 15 to 20 minutes (twice)

Comments: Glucagon causes an increase in serum glucose concentrations by converting hepatic glycogen to glucose. Adequate hepatic glycogen stores must exist for glucagon to be effective. The occurrence of severe hypoglycemia with adequate glycogen stores would most likely be seen in hyperinsulinemic states such as exists with infants of diabetic mothers. In addition, glucagon promotes hepatic gluconeogenesis using amino acids. Infusions of glucagon have been used to treat hypoglycemia in SGA infants (the hypoglycemia is thought to be secondary to delayed maturation of gluconeogenic enzymes and that supraphysiologic concentrations of glucagon may be required). Continuous infusions of 0.5 mg/kg/day to 2.0 mg/kg/day have been used to treat hypoglycemia (Carter. Arch Dis Child 1988; 63:1264-66; Belik. Pediatr 2001; 107:595-97), though published experience is limited.

Parenteral administration has also been noted to produce relaxation of smooth muscle in the stomach and the large and small intestines. Glucagon may be useful in counteracting severe hypoglycemia caused by insulin administration. If no effect is seen in 15 to 20 minutes, the dose may be repeated a second and third time, however in the face of persisting hypoglycemia, IV glucose would be the preferred choice of treatment. Glucagon also has an insulin-releasing effect, so that a glucose infusion should be started to prevent rebound hypoglycemia. [Drug Facts and Comparisons Olin, BR (editor) Facts and Comparisons, Inc.:St. Louis, MO. 1995:131.]

   Glucagon has been used to treat bradycardia and hypotension after maternal labetalol therapy for pre-eclampsia. Preterm infants may be particularly sensitive to these effects. In a case report, Stevens (J Pediatr 1995; 127:151-3) used doses of 0.3 mg/kg to 0.6 mg/kg to reverse a suspected beta-blockade (up to tenfold greater than that used to treat hypoglycemia). Multiple doses may be required as often as every hour. It can also be given as a continuous infusion based on the intermittent doses required to reverse symptoms of myocardial depression. The primary action of glucagon in beta-blockade toxicity is stimulation of calcium-dependent channel which results in an increase in the intracellular concentration of cyclic-AMP. Glucagon also stimulates adrenal catecholamine release.

Toxicity:  Carter reported thrombocytopenia occurring in 2 of the 25 infants treated with glucagon; Belik reorted a severe episode of hyponatremia and seizures thought to be due to an infusion of glucagon. Glucagon can cause insulin release, so hypoglycemia may occur with its use in patients with insulin secreting tumors. Glucagon decreases GI motility and is occasionally used to aid in some radiological examinations.

Preparation: Glucagon is supplied as a lyophilized powder with an accompanying diluent. Reconstitution with this diluent provides a 1 mg/cc solution (1 mg=1 unit) which is stable for 48 hours under refrigeration. The diluent contains phenol which is a myocardial depressant. The drug can be reconstituted using sterile water alone. If a lower final glucagon concentration is required, the phenol-reconstituted glucagon can be diluted with sterile water as well. The solution should be used immediately. Glucagon solutions should not be used unless they are clear and of a watery consistency.

Compatibility: Not compatible with TPN or filter.   No information available about other drugs.  Presume that it is compatible with sterile water only.