In this episode, I’ll discuss why glucagon is not given a strong recommendation in the AHA guidelines for cardiopulmonary resuscitation.
Glucagon is often considered a potential treatment for beta-blocker and calcium-channel-blocker overdose because it can increase heart rate, blood pressure, and cardiac contractility, regardless of whether beta receptors or calcium channels are blocked. These effects occur because glucagon directly increases cyclic AMP.
The 2023 AHA update to the guidelines for cardiopulmonary resuscitation and emergency cardiac care for patients with life-threatening poisoning includes extensive recommendations for both beta-blocker and calcium channel blocker poisoning, but glucagon does not feature prominently.
For beta-blocker toxicity, glucagon only receives a level 2a recommendation that it is reasonable to give as a bolus and continuous infusion, and for calcium channel blocker toxicity, the recommendation is level 2b, stating the usefulness of a glucagon bolus and infusion is uncertain.
The guideline authors prioritize vasopressors and high-dose insulin therapy for each type of toxicity, both of which receive level 1 strong recommendations.
The bottom line is that glucagon has side effects like vomiting and hyperglycemia, and weak evidence to support its use – essentially just case reports. In the case of calcium channel blocker toxicity, there are reports of tachyphylaxis to glucagon’s effects, limiting its potential usefulness.
Vasopressors and high-dose insulin therapy have much stronger evidence supporting clinical benefits in these patients, and the guideline authors want these therapies prioritized.
The topic in this episode is inspired by an in-depth training available to members of my Hospital Pharmacy Academy. The Hospital Pharmacy Academy is my online membership site that will teach you practical critical care and hospital pharmacy skills you can apply at the bedside so that you can become confident in your ability to save lives and improve patient outcomes. To get immediate access to this and many other resources to help in your practice, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply