2 Effects of glucagon, however, exceed glucoregulation: 3, 4 Data obtained from preclinical and uncontrolled clinical studies and case reports have shown that intravenous administrations of glucagon in high doses under most circumstances lead to increases in heart rate, blood pressure (BP), and cardiac contractility. ![]() 1 Because of the glucoregulatory effect, pharmacological glucagon preparations are used to counteract acute insulin‐induced hypoglycemia. Glucagon is best known for its ability to increase glucose production in the liver, thereby controlling fasting blood glucose levels in balance with insulin. Glucagon is a peptide hormone secreted by the alpha cells in the pancreas. Our results indicate that administration of high‐dose glucagon infusion instead of repeated bolus injections might be preferable for hemodynamic support in beta‐blocker–poisoned patients the results have potential clinical implications because glucagon administered as an infusion instead of bolus requires less glucagon for the same hemodynamic effects to occur. ![]() Procurement of enough glucagon in the emergency department for sustained hemodynamic support is a concern with glucagon therapy. Intravenous high‐dose glucagon is a recommended antidote against beta‐blocker poisonings, but clinical effects are currently unclear because of a lack of controlled clinical trials. Glucagon‐induced nausea occurred in 80% of participants despite ondansetron pretreatment. Hemodynamic effects of glucagon thus reflected pharmacologic glucagon plasma concentrations. Similar effects of glucagon bolus occurred on days with beta‐blockade and between 15 and 30 minutes during infusion. Compared with saline, glucagon bolus increased mean heart rate by 13.0 beats per minute (95% CI, 8.0–18.0 P<0.001), systolic blood pressure by 15.6 mm Hg (95% CI, 8.0–23.2 P=0.002), diastolic blood pressure by 9.4 mm Hg (95% CI, 6.3–12.6 P<0.001), and cardiac output by 18.0 % (95% CI, 9.7–26.9 P=0.003) at the 5‐minute time point on days without beta‐blockade. End points were hemodynamic and adverse effects of glucagon compared with saline. Glucagon/saline was administered from 0 minutes as a 2‐minute intravenous bolus or as a 30‐minute infusion (same total glucagon dose). On individual days, esmolol/saline was infused from −15 to 30 minutes. In a randomized crossover study, 10 healthy men received combinations of esmolol (1.25 mg/kg bolus+0.75 mg/kg/min infusion), glucagon (50 µg/kg), and identical volumes of saline placebo on 5 separate days in random order (saline+saline esmolol+saline esmolol+glucagon bolus saline+glucagon infusion saline+glucagon bolus). ![]() Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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