Glucagen

glucagon

GlucaGen

Indications

Action

Pharmacokinetics

Time/action profile

Contraindications/Precautions

Adverse Reactions/Side Effects

Cardiovascular

• hypotension

Gastrointestinal

• nausea (most frequent)
• vomiting (most frequent)

Miscellaneous

• hypersensitivity reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess for signs of hypoglycemia (sweating, hunger, weakness, headache, dizziness, tremor, irritability, tachycardia, anxiety) prior to and periodically during therapy.
• Assess neurologic status throughout therapy. Institute safety precautions to protect patient from injury caused by seizures, falling, or aspiration. For insulin shock therapy, 0.5–1 mg is administered after 1 hr of coma; patient usually awakens in 10–25 min. If no response occurs, repeat the dose. Feed patient supplemental carbohydrates orally to replenish liver glycogen and prevent secondary hypoglycemia as soon as possible after awakening, especially pediatric patients.
• Assess nutritional status. Patients who lack liver glycogen stores (starvation, chronic hypoglycemia, adrenal insufficiency) will require glucose instead of glucagon.
• Assess for nausea and vomiting after administration of dose. Protect patients with depressed level of consciousness from aspiration by positioning on side; ensure that a suction unit is available. Notify health care professional if vomiting occurs; patient will require parenteral glucose to prevent recurrent hypoglycemia.
• Lab Test Considerations: Monitor serum glucose levels throughout episode, during treatment, and for 3–4 hr after patient regains consciousness. Use of bedside fingerstick blood glucose determination methods is recommended for rapid results. Follow-up lab results may be ordered to validate fingerstick values, but do not delay treatment while awaiting lab results, as this could result in neurologic injury or death.
  • Large doses of glucagon may cause a ↓ in serum potassium concentrations.

Potential Nursing Diagnoses

Implementation

• May be given subcut, IM, or IV. Reconstitute with diluent supplied in kit by manufacturer. Inspect solution prior to use; use only clear, water-like solution. Solution is stable for 48 hr if refrigerated, 24 hr at room temperature. Unmixed medication should be stored at room temperature.
  • Administer supplemental carbohydrates IV or orally to facilitate increase of serum glucose levels.

• Intravenous Administration

• pH: 2.5–3.5.
• Diluent: Reconstitute each vial with 1 mL of an appropriate diluent. For doses ≤2 mg, use diluent provided by manufacturer. For doses >2 mg, use sterile water for injection instead of diluent supplied by manufacturer to minimize risk of thrombophlebitis, CNS toxicity, and myocardial depression from phenol preservative in diluent supplied by manufacturer. Reconstituted vials should be used immediately.Concentration: Not exceed 1 mg/mL.
• Rate: Administer at a rate not exceeding 1 mg/min. May be administered through IV line containing D5W.
• Continuous Infusion: Diluent: Reconstitute vials as per directions above (use sterile water for injection). Further dilute 10 mg of glucagon in 100 mL of D5W.Concentration: 0.1 mg/mL.
• Rate: See Route/Dosage section.
• Y-Site Compatibility: No information available.

Patient/Family Teaching

• Teach patient and family signs and symptoms of hypoglycemia. Instruct patient to take oral glucose as soon as symptoms of hypoglycemia occur—glucagon is reserved for episodes when patient is unable to swallow because of decreased level of consciousness.
• Home Care Issues: Instruct family on correct technique to prepare, draw up, and administer injection. Health care professional must be contacted immediately after each dose for orders regarding further therapy or adjustment of insulin dose or diet.
• Advise family that patient should receive oral glucose when alertness returns.
• Instruct family to position patient on side until fully alert. Explain that glucagon may cause nausea and vomiting. Aspiration may occur if patient vomits while lying on back.
• Instruct patient to check expiration date monthly and to replace outdated medication immediately.
• Review hypoglycemic medication regimen, diet, and exercise programs.
• Patients with diabetes mellitus should carry a source of sugar (such as a packet of sugar or candy) and identification describing disease process and treatment regimen at all times.

Evaluation/Desired Outcomes

• Increase of serum glucose to normal levels with improved level of consciousness.
• Smooth muscle relaxation of the stomach, duodenum, and small and large intestine in patients undergoing radiologic examination of the GI tract.