Glucagon

Downes, Michael A.

doi:10.1046/j.1442-2026.2003.00506.x

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…Synthetic glucagon is used in treatment of hypoglycemia. 7,8 Glucagon also has a positive inotropic and chronotropic effect on myocardial tissue. It has been accepted as the standard treatment in the early management of patients with severe β-blocker overdose and for the myocardial depression produced by calcium channel blocker overdose, although the evidence is still limited to the animal studies.…”

Section: Introductionmentioning

confidence: 99%

“…9 A review of the literature reveals some individual case reports, which show the favorable effects of glucagon in TCA overdose. 7,10,11 There is one experimental study found to be existing in which glucagon was found to be ineffective in a dog model of TCA overdose. 12 Therefore, the present study was planned to investigate the effects of glucagon on mean arterial pressure (MAP), heart rate (HR), and QRS duration in anesthetized rat model of TCA overdose.…”

Section: Introductionmentioning

confidence: 99%

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Effect of glucagon on amitriptyline-induced cardiovascular toxicity in rats

et al. 2008

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The aim of this study was to investigate the effect of glucagon on cardiovascular parameters in anesthetized rat model of tricyclic antidepressant overdose. Toxicity was induced by infusion of amitriptyline 0.94 mg/kg/min until a 40–45% of reduction in mean arterial pressure was observed. Amitriptyline infusion rats were then randomized into three groups. Control group of rats (group 1) received a bolus of 5% dextrose followed by the continuous infusion of dextrose, whereas treatment groups received 1 mg/kg (group 2) or 2 mg/kg (group 3) bolus doses of glucagon followed by continuous infusion (0.1 mg/kg/min) of glucagons for 60 min. Mean arterial pressure, heart rate, and electrocardiogram were recorded. Amitriptyline caused a significant decrease in mean arterial pressure and a prolongation in QRS, yet it did not change the heart rate. High-bolus dose of glucagon (2 mg/kg) followed by glucagon infusion significantly increased mean arterial pressure at 40, 50, and 60 min ( P < 0.05) and shortened the prolonged QRS at 50 and 60 min ( P < 0.05) when compared with control group. There was also a significant increase in heart rate. In conclusion, bolus doses followed by a continuous infusion of glucagon were found to be effective in reversing the hypotension and QRS prolongation in the rat model of amitriptyline toxicity. Further studies are needed to reveal the exact mechanism of the proposed effect.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of glucagon on amitriptyline-induced cardiovascular toxicity in rats

et al. 2008

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“…Recent experimental studies have shown that many agents, such as L-NAME, a nitric-oxide synthase inhibitor, selective adenosine A 1 and A 2a receptor antagonists, and glucagon, are effective in reversing TCA-induced hypotension (Kalkan et al, 2004;Pentel et al, 1996;Tuncok et al, 2002;Kaplan et al, 2008). There are case reports suggesting the beneficial effects of vasopressin and glucagon in TCA overdose (Sensky and Olczak, 1999;Downes, 2003;Barry et al, 2006). Heard et al showed that TCA antibody fragments (TCA Fab) raise total serum TCA levels while lowering free levels in TCA-poisoned patients and no toxic effects were associated with the increase in TCA levels, but in this study, there were no significant changes in QRS duration, HR, or MAP associated with the Fab infusion (Heard et al, 2006).…”

Section: Discussionmentioning

confidence: 97%

An alternative antidote therapy in amitriptyline-induced rat toxicity model: theophylline

Oransay

Kalkan

Hocaoğlu

et al. 2010

Drug and Chemical Toxicology

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We planned this study in order to investigate the effects of theophylline on cardiovascular parameters in an anaesthetized rat model of amitriptyline toxicity. In the preliminary study, we tested theophylline as 1 mg/kg of bolus, followed by a 0.5-mg/kg infusion. Toxicity was induced by the infusion of 0.94 mg/kg/min of amitriptyline up to the point of a 40-45% inhibition of mean arterial pressure (MAP). The rats were randomized to two groups: a group of 5% dextrose bolus followed by 5% dextrose infusion, and another group with theophylline bolus followed by infusion. Amitriptyline caused a significant decrease in MAP and prolongation in QRS; however, it did not alter heart rate (HR). When compared to the dextrose group, theophylline administration increased MAP, shortened prolonged QRS duration, and increased HR (P < 0.05, respectively). There was no statistically significant difference in the results of arterial blood-gas analyses among the groups (P > 0.05). Bolus doses followed by a continuous infusion of theophylline were found to be effective in reversing the hypotension and QRS prolongation seen in amitriptyline toxicity. One of the possible explanations of this beneficial effect is nonselective adenosine antagonism of theophylline. Further studies are needed to reveal the exact mechanism of the observed effect.

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“…Glucagon counters hypoglycaemia mainly by stimulating hepatic glycogenolysis and gluconeogenesis with a following release of endogenously produced glucose to the blood. One should note the possible hepatic glucose depletion seen in alcohol‐induced hypoglycaemia . Nonetheless, in half of the cases, intramuscular (IM) glucagon 1 mg was reported to have a marked plasma glucose elevating effect.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review on Insulin Overdose Cases: Clinical Course, Complications and Treatment Options

Johansen

Christensen

2018

Basic Clin Pharma Tox

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A large overdose of insulin is a serious health matter. Information concerning administration and duration of intravenous (IV) glucose, other treatment options or complications besides hypoglycaemia following large insulin overdoses is not readily apparent from the literature. A systematic search, compilation and review of case reports on insulin overdoses, published 1986-2017, was performed in PubMed, EMBASE, Cochrane and PROSPERO databases. Of 1523 published articles, 45 cases of insulin overdoses were included with a total median insulin dose of 900 international units (IU) (range 26-4800 IU). Hospitalization occurred in 44 cases with a median hospitalization duration of 94 hr (range 12-721 hr), and one-third (n = 15) admitted to the intensive care unit. First-line treatment was IV glucose treatment in 95% of cases. Treatment options besides IV glucose that were reported beneficial included glucagon IV or intramuscular (IM), octreotide IV or IM, surgical excision, hydrocortisone IV and oral intake of complex carbohydrates. Prevalent complications were intermittent cerebral impairment (73%), hypokalaemia (49%), other electrolyte disturbances (42%), and hepatic disturbances (7%) and cardiac toxicity (e.g. cardiac arrhythmia) (9%). Long-term consequences were one case of lasting hypoglycaemic encephalopathy and one death. In conclusion, following large insulin overdoses, in-hospital admission and treatment with IV glucose may be needed for up to a week. Monitoring of electrolytes and hepatic and cardiac functions seems important. Several experimental treatment options may be considered in addition to glucose administration. With appropriate pre- and in-hospital treatment, cases with severe hypoglycaemia and neurologic complications may have a favourable outcome.

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Glucagon

Abstract: Despite its infrequent usage, glucagon is an important drug in the ED. It has both well established and less well established indications. This article reviews its role for the practising emergency physician.

Cited by 6 publications

References 34 publications

Effect of glucagon on amitriptyline-induced cardiovascular toxicity in rats

Effect of glucagon on amitriptyline-induced cardiovascular toxicity in rats

An alternative antidote therapy in amitriptyline-induced rat toxicity model: theophylline

A Systematic Review on Insulin Overdose Cases: Clinical Course, Complications and Treatment Options

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