A couple caveats to maximizing glucagon's utility:
- Glucagon decreases resting tone of the lower esophageal sphincter. It has no effect on the upper third of the esophagus and minimal effect on the middle third; Hence, foreign bodies stuck in these locations are less likely to be dislodged by glucagon administration.
- Administer 0.25 - 2 mg IV slowly over 1 - 2 minutes (to minimize nausea/vomiting side effect), then 1 minute later give the patient some water to stimulate esophageal peristalsis. If no effect after 20 minutes, can attempt again.
- Contraindications: insulinoma (while glucagon will intially elevate glucose via hepatic glycogenolyss and gluconeogenesis, it will stimulate excessive insulin secretion in this condition), pheochromocytoma (stimulates catecholamine release), Zollinger-Ellison syndrome (stimulates excessive gastric acid production), glucagon hypersensitivity, or sharp esophageal foreign body.
- If glucagon fails, other pharmacologic maneuvers to consider include nitroglycerin, gas forming agents (ex soda)
With the holiday season now in full force, I'm sure the ER will be seeing its fair share of patients with turkey, chicken, beef and other sundry meats stuck in the upper GI tract. Perhaps this info will come in handy. Cheers and Happy Thanksgiving!
Source
Munter, David MD and Heffner, Alan MD. "Esophageal Pharmacologic Maneuvers." Roberts: Clinical Procedures in Emergency Medicine, 4th ed. 2004.
Glucagon: Drug information. Up to Date.
