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Glucagon for Hypoglycemia
Glucagon Infusion for Treatment of Hypoglycemia: Efficacy and Safety in Sick Preterm Infants. Charsha DS, McKinley PS, and Whitfield JM. Baylor University Medical Center, Dallas TX.
The safety of using glucagon to treat persistent hypoglycemia in preterm infants has recently been called into question due to a reported association of this therapy with hyponatremia and thrombocytopenia (Pediatrics 107:595-7). This study reviewed the charts of 28 preterm infants who had received IV glucagon infusions (20-40 mcg/hr) for hypoglycemia. The birth weight of the study infants was 1814 +/- 780 g, EGA 32 +/- 3 weeks and Apgar 5 +/- 3 at 1 minute. The glucagon infusion began at 42 (3 – 310) hours and was continued for 77 (9 – 344) hours. Blood glucose increased to >60 mg/dl in 2.2 +/- 1.6 hours. Thrombocytopenia was not associated with this therapy. Severe hyponatermia ( Na < 120 mEq/l) occurred in only 1 patient (4%) and was easily corrected.
Comment. The use of glucagon for hypoglycemia in preterm babies remains controversial. It has been reported to be associated with severe hyponatremia (with seizures) and thrombocytopenia (requiring transfusion). In adults, glucagon is also reported to cause nausea, vomiting, decreased bowel motility and a depression of vitamin K-sensitive clotting factors. My approach to treating persistent hypoglycemia in preterm babies is to first increase the glucose infusion rate up to 8-12 mg/kg/minute. If that fails to correct the problem, then I would try adding hydrocortisone before resorting to glucagon.