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#5945 - 06/25/05 04:52 PM

A case for Glucagon?

Matt Schickel
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Registered: 06/22/03
Posts: 205
Loc: Troublemakersville

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So our story begins at 21 waller. Oh ya. So we have a large, dare I say morbidly obese diabetic female who is profoundly hypoglycemic and not a candidate for oral glucose. I think we stuck her 7, maybe 8 times, before we got a 22ga. Good job, Bob. Anyways, so we got an EXTREMELY difficult IV, 22ga. Have you ever tried to push D50 through a 22? So, Bob made a bag of D0.16... confused? D50 into a 250 bag of NS. you do the math. Anyways, nevermind the fact that it was really hard to see the infusion site due the large amount of adipose tissue (I pray you know why I'm bringing this up), it took a long time to infuse the dextrose to this woman's starving brain. Keep in mind, the brain needs 2 things - O2 and sugar. Without one, cerebral damage can occur, and in short time. So, in this story, she woke up, everything was hunky dory and we all lived happily ever after.

Let's play the "what if" game. What if we would not have been able to get said IV? End of the road, right? Throw her on the stretcher and run code 3 to the nearest hospital (Brack)? Good luck with them even being open! So, here we are with a patient whose brain is starving, maybe even infarcting.

The bottom line is the quality of this patient's life if damage occurs. How horrible would that be if she suffered damage to her brain when Glucagon, a relatively benign and extremely helpful drug (for just this situation), could have maybe changed her outcome? What if?

_________________________
People are a lot like Slinkys. They are not good for much but are a lot of fun to push down a flight of stairs.

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#5946 - 06/25/05 05:45 PM

Re: A case for Glucagon? [Re: Matt Schickel]

Liz Yankiver
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Registered: 05/06/03
Posts: 436
Loc: Austin

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I support your want for Glucagon. We had a 70 year old female with a sugar of 25, started as a hypoglycemic call and quickly progressed into a cardiac arrest. We stuck this woman 7 times, EJ failed, and 2 closest hospitals were closed. We got pulses with pacing but this poor woman's brain was starving when we got to STDH. I honestly feel that it was this woman's time to go, but I would have liked to let her do that with a glucose of at least 50.
I did talk to my commander about this and she suggested in the future to try and get an order to drop an NG tube and give it that way, or use the oral glucose carefully and let it dissolve between the cheek and gum. Just things to think about....

_________________________
"This thing we call 'failure' is not the falling down, but the staying down."- Pickford

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#5947 - 06/25/05 06:10 PM

Re: A case for Glucagon? [Re: Liz Yankiver]

Corey Ricketson
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Registered: 03/05/03
Posts: 379
Loc: Round Rock

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As we progress in our medicine I think our goal should be to propose medicines that have more than one purpose. Glucagon is one of these truly remarkable drugs. It's primary use is for the case mentioned above. It is prescribed as an emergency drug for diabetics. Other uses are:

Beta-blocker OD
Beta-blocker induced bronchospasm
Anaphylactic reaction for a patient on Beta-blockers (epi aint gonna work)
foreign body obstruction in an esophagus (the case i mentioned)
TCA overdose after Sodium Bicarbonate
Calcium Channel blocker OD after Calcium

Drugs which offer us more bang for our buck should be pushed on our agenda. Drugs which are used for only one type of situation and that situation doesn't happen except once in a blue moon should be avoided. IE. Dobutamine.

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