One hour post-glucagon resumption the BP was 114/79 mmHg. The blood pressure at one hour after placing on insulin-dextrose alone was 95/57 mmHg and then glucagon infusion at 9 mg/h was reintroduced after the arrival of the pharmacy stock. Actrapid HM 6 IU/h based on an estimated body weight of 60 kg and dextrose 6 g/h were subsequently added in view of a BP of 92/63 mmHg at the end of the first hour of glucagon infusion. Calcium chloride 1 g was repeated and glucagon infusion at 9 mg/h was commenced. With a second dose of glucagon at 6 mg and 10 ml of 10% calcium chloride administered 17 minutes later, the BP rose to 107/78 mmHg and she vomited twice. After receiving intravenous glucagon 3 mg over 5 minutes, her BP increased to 88/63 mmHg. Two hundred millilitres of normal saline were administered as intravenous bolus but the BP 30 minutes later was 75/57 mmHg. 2007 14:113-118) β, FHKAM(Emergency Medicine) Kam Chak Wah, MRCP, FRCSEd, FHKAM(Emergency Medicine) of 226 msec. The discussion is focused on the role of antidotes and catecholamine inotropes in the management of beta-blocker and calcium channel blocker poisoning. The blood pressure was subsequently stabilised by continuous glucagon infusion with the aid of an insulin-dextrose drip. It also comes as a powder to be mixed with a provided liquid to be injected subcutaneously, intramuscularly (into the muscle), or intravenously (into a vein).We report a case of metoprolol and nifedipine overdose complicated by hypotension which responded to intravenous boluses of calcium chloride and glucagon. Glucagon comes as a solution (liquid) in a prefilled syringe and an auto-injector device to inject subcutaneously (just under the skin). You need glucagon if your blood sugar level is less than 50 mg/dl and you are: Unable to eat or drink safely because you’re confused or disoriented. For children, withdraw ½ of the solution from the bottle (0.5 mg mark on syringe). For children weighing less than 44 lb (20 kg), give ½ adult dose (0.5 mg). TO INJECT GLUCAGON The usual adult dose is 1 mg. Hypotension should first be treated with intravenous fluids, then calcium, insulin/dextrose and vasopressors. Treatment options for CCB-induced bradycardia include atropine, cardiac pacing, and possibly calcium and glucagon. There is no “magic bullet” antidote for CCB poisoning. How do you reverse a calcium channel blocker? Because a glucagon bolus can be diagnostic and therapeutic, the clinician can empirically administer glucagon and check for a response. Glucagon can enhance myocardial contractility, heart rate, and atrioventricular conduction many authors consider it the drug of choice for beta-blocker toxicity. What medication do you give for a beta blocker overdose? Cases refractory to fluids, atropine, and glucagon should be considered candidates for high-dose insulin, euglycemia (HIE) treatment. Treatment with calcium salts may provide benefits for hypotensive patients who overdosed on beta-blockers alone or in combination with a calcium channel blocker. What do you give for a metoprolol overdose? In order to support gluconeogenesis, glucagon promotes skeletal muscle wasting to supply amino acids as gluconeogenic precursors. Glucagon opposes hepatic insulin action and enhances the rate of gluconeogenesis, increasing hepatic glucose output. How does glucagon increase gluconeogenesis? Glucagon injection is an emergency medicine used to treat severe hypoglycemia (low blood sugar) in diabetes patients treated with insulin who have passed out or cannot take some form of sugar by mouth. Glucagon has also been used in the setting of calcium channel blocker toxicity. Glucagon is traditionally considered a first line antidote for beta-blocker overdose. Note that the actions of glucagon oppose those of insulin, yet both have beneficial effects in treating CCB toxicity. Glucagon promotes calcium entry into cells via stimulation of a receptor that is considered to be separate from adrenergic receptors. How does glucagon reverse calcium channel blocker overdose?
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