Glucagon: Prehospital therapy for hypoglycemia

Vukmir, Rade B.; Paris, Paul M.; Yealy, Donald M.

doi:10.1016/s0196-0644(05)81658-0

Cited by 45 publications

(1 citation statement)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 A literature search retrieved a number of papers evaluating the use of 50% dextrose and glucagon. [5][6][7][8][9][10][11][12] However, no research was found that evaluated 10% dextrose for the treatment of hypoglycaemia, although one paper reported that, as with any hypertonic solution, extravasation injury is possible. 13 This randomised controlled trial aimed to compare the efficacy and safety of 5 g aliquots of 10% and 50% dextrose in the out of hospital treatment of adult hypoglycaemic patients.…”

mentioning

confidence: 99%

Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial

Moore¹,

Woollard

2005

Emergency Medicine Journal

View full text Add to dashboard Cite

Objective: To investigate whether 10% dextrose given in 5 g (50 ml) aliquots is more effective than 50% dextrose given in 5 g (10 ml) aliquots in the treatment of out of hospital hypoglycaemia. Design: Randomised controlled trial. Setting: Out of hospital patients attended by paramedics from a large UK ambulance service. Participants: 51 unresponsive adult patients with blood glucose levels (4 mmol/l. Intervention: 5 g (50 ml) intravenous aliquots of 10% dextrose or 5 g (10 ml) intravenous aliquots of 50% dextrose to a maximum dose of 25 g. Main outcome measures: To compare for each dextrose concentration the time to achieve a Glasgow Coma Scale (GCS) score of 15, and the dose required to obtain a blood glucose level of >4.5 mmol/l. Results: There were no statistically significant differences between the groups with regard to age or sex, median pretreatment GCS, pretreatment blood glucose level, or proportion of patients with insulin dependent diabetes. Following treatment, there were no statistically significant differences in median time to recovery (8 minutes), median post-treatment GCS, or number of subjects experiencing a further hypoglycaemic episode within 24 hours (four per group). The median total dose of dextrose administered was significantly less with the 10% concentration (10% = 10 g, 50% = 25 g, p,0.001) and median posttreatment blood sugar levels were also significantly lower (10% = 6.2 mmol/l and 50% = 9.4 mmol/l, p = 0.003). There were no reports of extravasation injuries in either group. Conclusions: Dextrose 10% delivered in 5 g (50 ml) aliquots is administered in smaller doses than dextrose 50% delivered in 5 g/10 ml aliquots, resulting in lower post-treatment blood glucose levels. We therefore recommend it as the intravenous treatment of choice for adult hypoglycaemia. B efore 1999, 50% dextrose and glucagon were the principal treatments available to UK emergency ambulance personnel caring for unconscious or unresponsive hypoglycaemic patients. Dextrose 50% is a hypertonic solution of glucose available in prefilled syringes containing 25 g glucose in 50 ml water (IMS mini-jet, International Medication Systems (UK), Leatherhead, Surrey, England). In south-east Wales, at the time of this study, it was administered intravenously in 5-10 g (10-20 ml) increments, titrated against effect after confirming hypoglycaemia by capillary or venous blood sugar level.High concentrations of glucose can cause cerebral oedema and death in children.1 In 1999, a revised UK paramedic training syllabus and manual were introduced and in 2000, the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) published its prehospital treatment guidelines. Both recommended 10% dextrose for the reversal of hypoglycaemia in children and pregnant women. Subsequently, 10% dextrose became available in most UK ambulances and its use was recommended for the reversal of all hypoglycaemic episodes. 4A literature search retrieved a number of papers evaluating the use of 50% dextrose and glucagon.5-12 However, no research was foun...

show abstract