Glucagon is a pancreatic polypeptide hormone that has diverse utility as both a therapeutic and diagnostic agent. Many of its pharmacologic actions are pertinent to the practice of emergency medicine. The author reviews the literature supporting each potential use of the drug and the purported physiologic mechanisms by which glucagon exerts these actions. The indications and proper dosages for glucagon in the acute care setting are summarized.

Utility of glucagon in the emergency department.

The polypeptide hormones glucagon, secretin, and vasoactive intestinal peptide have homologous structures in the amino acid terminal region (Jorpes 1968) and are known to release insulin, inhibit intestinal smooth muscle, increase blood glucose, mobilize free fatty acids, and increase cardiac rate and contractile force (Farah and Tuttle 1960; Ross 1970; Chiba 1976; Said et al. 1972). Chatelain et al. (1979) have shown in rat heart homogenates that these polypeptides activate the adenylate cyclase in the presence of guanosine triphosphate. These findings suggest that these hormones act via similar mechanisms although they may not activate the same receptor (Chatelain et al. 1979a).

Glucagon and the Heart

Einmalige und wiederholte i.v. Bolusinjektionen von Glucagon fuhren bei gesunden Probanden zu einem Anstieg der Herzfrequenz, des systolischen Blutdruckes und einer vom Frequenzeffekt unabhangigen, mechanokardiographisch fasbaren Kontraktilitatssteigerung des Herzens. Das Wirkungsmaximum liegt zwischen der 1. und 4 min und klingt uber 30 min ab. Die klinische Anwendung bei therapierefraktarer kardialer Dekompensation und bei Rhythmusstorungen [1, 2, 3, 6, 7] verlangt im allgemeinen eine langer anhaltende, gleichmasige Wirkung. Es war deshalb zu prufen, ob durch i.v. Glucagoninlusionen oder durch subcutane Injektionen einer Depotform des Glucagons Effekte erzielt werden konnen, die mit der Wirkung einer i.v. Bolusgabe vergleichbar sind.

Kreislaufwirkungen verschiedener Applikationsformen von Glucagon

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Kreislaufwirkungen verschiedener Applikationsformen von Glucagon