title: Glucagon-induced hypertensive emergency: a case report.
abstract: Glucagon is well acknowledged as a sphincter of Oddi relaxant for both diagnostic and therapeutic uses in choledocholithiasis, and an empiric treatment for β-blocker overdose. Although it has been implicated in inducing cardiovascular crises in patients with asymptomatic pheochromocytoma, adverse effects in other patient populations have not been characterized. This case report describes a patient with hypertension controlled on β blockers who, after glucagon administration during an intraoperative cholangiography, experienced hypertensive emergency despite adequate pain control. Nitroglycerin acted as a key agent to decrease the patient's blood pressure as well as a secondary relaxant of the sphincter of Oddi. The patient had no radiographic evidence of pheochromocytoma. As out-of-operating room and intraoperative uses of glucagon continue to increase, perioperative physicians should be aware of its potential hemodynamic effects even in healthy populations.
authors.affiliation: Department of Anesthesiology, Yale-New Haven Hospital. Electronic address: aron.legler@yale.edu.
authors.forename: Aron
authors.initials: A
authors.lastname: Legler
authors.affiliation: Yale School of Medicine.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology, Yale-New Haven Hospital.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Chawla
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D004630:Emergencies; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects*; D005934:Glucagon / Q000009:adverse effects*; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D006973:Hypertension / Q000139:chemically induced* / Q000188:drug therapy; D007741:Labetalol / Q000627:therapeutic use; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D005765:Gastrointestinal Agents; D014665:Vasodilator Agents; D006830:Hydralazine; D005934:Glucagon; D005996:Nitroglycerin; D007741:Labetalol
keywords: Beta-blocker; Glucagon; Pharmacology