title: Successful administration of intranasal glucagon in the out-of-hospital environment.
abstract: We present a case of successful prehospital treatment of hypoglycemia with intranasal (IN) glucagon. Episodes of hypoglycemia can be of varying severity and often requires quick reversal to prevent alteration in mental status or hypoglycemic coma. Glucagon has been shown to be as effective as glucose for the treatment of hypoglycemia. The inability to obtain intravenous (IV) access often impairs delivery of this peptide and is therefore frequently given via the intramuscular (IM) route. Intranasal administration of glucagon has been shown to be as effective as the IV route and may be used for rapid correction of hypoglycemic episodes where IV access is difficult or unavailable and IM administration is undesirable. We describe the first documentation in the peer-reviewed literature of the successful treatment and reversal of an insulin-induced hypoglycemic episode with IN glucagon in the prehospital setting. We also present a review of the literature regarding this novel medication administration route.
authors.affiliation: Department of Emergency Medicine, Truman Medical Center , Kansas City, MO 64108, USA. ted.sibley@tmcmed.org
authors.forename: Ted
authors.initials: T
authors.lastname: Sibley
authors.forename: Ryan
authors.initials: R
authors.lastname: Jacobsen
authors.forename: Joseph
authors.initials: J
authors.lastname: Salomone
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005934:Glucagon / Q000008:administration & dosage* / Q000627:therapeutic use; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D005765:Gastrointestinal Agents; D007004:Hypoglycemic Agents; D007328:Insulin; C479079:insulin glulisine; D005934:Glucagon; D005947:Glucose