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Intravenous Dilution Guidelines

GLUCAGON

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

D5W, NS

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

[Recommended concentration: 0.1 mg/ml]
[5 mg] [50 ml]
[10 mg] [100 ml]
[20 mg] [200 ml]

May be given as a bolus or continuous infusion (See Comments)

Stability / Miscellaneous

Stability: Reconstituted solutions should be used immediately; any unused portion should be discarded.

Use diluent provided only if dose is < 2 mg otherwise dilute vials with sterile water or D5W to prevent phenol toxicity.  After all of the vials have been reconstituted, follow the dilutions listed above: eg 10mg/100 ml D5W or NS.

Beta-blocker overdose:
Separate glucagon receptors stimulate adenylcyclase improving heart rate, blood pressure and conduction defects. Adults: 3 - 5 mg (up to 10 mg) rapid IV push followed by an IV drip of 0.07 mg/kg/hr (usually 1 to 5 mg/hour) (The dose used to increase glucose in hypoglycemic patients is only 0.5 - 1 mg IM, IV, or SC).   Note: bolus dose may be repeated in 10 minutes. Usually causes nausea and vomiting. May give Reglan IV, Compazine or Tigan.

Calcium Channel blocker overdose:  [See beta-blocker protocol above or review the following excerpt from:   S. Doyon. Calcium Channel Blocker Overdose - MARYLAND POISON CENTER. TOXALERT: Volume 17, Issue 1: January, 2000]       The initial dose of glucagon is 3 mg IV over 1 minute. If ineffective, it should be followed by a 7 mg dose over 1 minute. The onset of action of glucagon is within 5 minutes and the duration of action is 15 minutes. Therefore, the bolus must be followed with an infusion of 3-5 mg or more per hour in order to support the heart rate and blood pressure. Hyperglycemia and vomiting are the adverse events most often associated with glucagon administration. It is, therefore, recommended that the patient have an NG tube placed followed by low wall suction, and that blood glucose be closely monitored with the administration of insulin to treat hyperglycemia (when blood sugars reach double the baseline).



Monitor blood glucose levels in hypoglycemic patients until they are asymptomatic; effective in treating hypoglycemia only if sufficient liver glycogen is present; since liver glycogen availability is necessary to treat hypoglycemic patients, glucagon has virtually no effects on patients in states of starvation, adrenal insufficiency, or chronic hypoglycemia.

Recommended routes: IM, IV, or SC.
Half-life: 8 to 18 minutes.


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DOSAGE AND ADMINISTRATION
General Instructions for Use:
* The diluent is provided for use only in the preparation of glucagon for parenteral injection and for no other use.
* Glucagon should not be used at concentrations greater than 1 mg/mL (1 unit/mL).
* Reconstituted glucagon should be used immediately. Discard any unused portion.
* Reconstituted glucagon solutions should be used only if they are clear and of a water-like consistency.
* Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.

Directions for Treatment of Severe Hypoglycemia:
Severe hypoglycemia should be treated initially with intravenous glucose, if possible.

1. If parenteral glucose can not be used, dissolve the lyophilized glucagon using the accompanying diluting solution and use immediately.
2. For adults and for pediatric patients weighing more than 44 lb (20 kg), give 1 mg (1 unit) by subcutaneous, intramuscular, or intravenous injection.
3. For pediatric patients weighing less than 44 lb (20 kg), give 0.5 mg (0.5 unit) or a dose equivalent to 20 to 30 µg/kg.2-6
4. Discard any unused portion.
5. An unconscious patient will usually awaken within 15 minutes following the glucagon injection. If the response is delayed, there is no contraindication to the administration of an additional dose of glucagon; however, in view of the deleterious effects of cerebral hypoglycemia emergency aid should be sought so that parenteral glucose can be given.
6. After the patient responds, supplemental carbohydrate should be given to restore liver glycogen and to prevent secondary hypoglycemia.

Directions for Use as a Diagnostic Aid:
Dissolve the lyophilized glucagon using the accompanying diluting solution and use immediately. Discard any unused portion.

The doses in the following table may be administered for relaxation of the stomach, duodenum, and small bowel, depending on the onset and duration of effect required for the examination. Since the stomach is less sensitive to the effect of glucagon, 0.5 mg (0.5 units) IV or 2 mg (2 units) IM are recommended.
Dose Route of Administration Time of Onset of Action Approximate Duration of Effect
* Administration of 2 mg (2 units) doses produces a higher incidence of nausea and vomiting than do lower doses.
0.25-0.5 mg(0.25-0.5 units) IV 1 minute 9-17 minutes
1-mg (1 unit) IM 8-10 minutes 12-27 minutes
2 mg*(2 units) IV 1 minute 22-25 minutes
2 mg*(2 units) IM 4-7 minutes 21-32 minutes

For examination of the colon, it is recommended that a 2 mg (2 units) dose be administered intramuscularly approximately 10 minutes prior to the procedure. Colon relaxation and reduction of patient discomfort may allow the radiologist to perform a more satisfactory examination.

HOW SUPPLIED
Glucagon Emergency Kit for Low Blood Sugar (Glucagon for Injection [rDNA origin]) (MS8031):

1 mg (1 unit) — (VL7529), with 1 mL of diluting solution (Hyporet®1 HY7530) (1s) NDC 0002-8031-01


Stability and Storage:
Before Reconstitution— Vials of Glucagon, as well as the Diluting Solution for Glucagon, may be stored at controlled room temperature 20° to 25°C (68° to 77°F)[see USP].

The USP defines controlled room temperature by the following: A temperature maintained thermostatically that encompasses the usual and customary working environment of 20° to 25°C (68° to 77°F); that results in a mean kinetic temperature calculated to be not more than 25°C; and that allows for excursions between 15° and 30°C (59° and 86°F) that are experienced in pharmacies, hospitals, and warehouses.

After Reconstitution— Glucagon for Injection (rDNA origin) should be used immediately. Discard any unused portion.

Literature revised February 18, 2005
Eli Lilly and Company
Indianapolis, IN 46285, USA
Copyright © 1999, 2005, Eli Lilly and Company. All rights reserved.

Source: [package insert]
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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