Glucagon infusion dose
Reading File
Finding Sources
Searching the Web
glucagon infusion dose mg/hour clinical indications 2024
Reading File
Here is a complete, source-verified summary of glucagon infusion dosing across all major clinical contexts:
Glucagon Infusion Dose
1. Beta-Blocker Toxicity (primary indication for infusion)
| Step | Adults | Pediatric |
|---|---|---|
| IV Bolus | 3-10 mg IV over 3-5 min | 30-150 mcg/kg IV |
| Continuous Infusion | 1-5 mg/hour | 20-70 mcg/kg/hour |
| Titration | Titrate to hemodynamic effect | Same |
| Max dose | No identified maximum | No identified maximum |
- Onset of bolus effect: 1-2 minutes; peak at 5-7 min; duration only 10-15 min (hence the need for infusion)
- Start the infusion at the same hourly rate as the bolus dose that achieved response (e.g., if 5 mg bolus worked, run at 5 mg/hour)
- Tachyphylaxis can occur with prolonged use
Tintinalli's Emergency Medicine, block 16, lines 1936-1938
2. Calcium Channel Blocker Toxicity (second-line, off-label)
| Adults | Adolescents | Children | |
|---|---|---|---|
| Bolus | 3-10 mg IV | 5-10 mg IV | 0.03-0.15 mg/kg (max 10 mg) |
| Infusion | 1-10 mg/hour | 1-5 mg/hour | 0.05-0.1 mg/kg/hour |
| Max initial rate | - | 5 mg/hour | 5 mg/hour |
- Second-line therapy (after calcium, epinephrine, high-dose insulin/dextrose)
- Optimize high-dose insulin euglycemic therapy (HIET) first unless glucagon is readily available in large supply
3. Neonatal Hyperinsulinemic Hypoglycemia (congenital hyperinsulinism, off-label)
| Population | Dose |
|---|---|
| Neonates (continuous infusion) | 0.001-0.02 mg/kg/hour IV or SC |
| Neonates (alternate regimen) | 0.5-1 mg/day (~0.01-0.02 mg/kg/hour) |
- Administer concurrent IV dextrose
- Wean over 24-72 hours once blood glucose is stable
- If given with octreotide, start at the lower rate (0.001 mg/kg/hour)
4. Cardiac Disease / Positive Inotropic Use (historical/research context)
- Doses of 0.5-16 mg/hour by continuous infusion were used for periods of 5-166 hours in older cardiac studies (FDA label historical data)
- Not a standard current indication
Key Practical Notes
- Supply problem: Glucagon comes only in 1 mg/1 mL vials requiring reconstitution. A 5 mg/hour infusion needs 5 vials per hour - most hospitals do not stock enough for prolonged infusions. Pre-emptively secure supply from pharmacy.
- Side effects: Nausea and vomiting (consider pre-treating with antiemetics; check QT before ondansetron). Hypokalemia with high doses - supplement potassium. Aspiration risk with altered mental status patients.
- Tachyphylaxis: Positive inotropic/chronotropic effects may not be maintained long-term.
- Hypoglycemia (acute, severe): Typically a single 1 mg IM/SC/IV dose, not a continuous infusion in most adults.
Sources:
- Tintinalli's Emergency Medicine, block 16, lines 1934-1940
- PDR/prescribing information for glucagon (beta-blocker/CCB overdose dosing)
- FDA glucagon prescribing information
- StatPearls - Glucagon
This is a shared conversation. Sign in to Orris to start your own chat.