Abstract
Background/Aims: Continuous intravenous glucagon is frequently used in the management of severe congenital hyperinsulinism (HI), but its efficacy in these patients has not been systematically evaluated. The aim of this study was to describe the use of continuous intravenous glucagon and to evaluate its effect on the glucose infusion rate (GIR) requirement in infants with HI.
Methods: Retrospective chart review of children with HI who received continuous intravenous glucagon for prevention of hypoglycemia at the Children’s Hospital of Philadelphia between 2003 and 2013.
Results: Forty (22 male) infants were included, and median (IQR) age at glucagon treatment was 29 (23, 54) days. Median glucagon dose was 205 (178, 235) mcg/kg/day and duration of treatment was 5 (3, 9) days. GIR reduced from 18.5 (12.9, 22.8) to 11 (6.6, 17.5) mg/kg/min 24 h after starting glucagon (p < 0.001), and hypoglycemia frequency reduced from 1.9 (1.3, 2.9) to 0.7 (0.3, 1.2) episodes per day. Vomiting (n = 11, 13%), rash (n = 2, 2%), and respiratory distress (n = 15, 19%) were seen during glucagon treatment.
Conclusion: An intravenous glucagon infusion reduces the required GIR to maintain euglycemia, decreasing the risks associated with the administration of high fluid volume or fluids with high-glucose concentrations.
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Abbreviations
- GIR:
-
Glucose infusion rate
- HI:
-
Hyperinsulinism
- KATP :
-
ATP-sensitive potassium channel
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Communicated by: Gerard T. Berry, M.D.
Appendices
Funding Sources
This study was supported by training grant T32DK063688-13S to J.J.L. and grant 5R01DK098517 to D.D.D.L.
Compliance with Ethics Guidelines
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5).
Conflict of Interest
Colin Hawkes, Juan Lado, Stephanie Givler, and Diva D. De Leon declare that they have no conflict of interest.
Author Contributions
Colin Hawkes analyzed data and wrote the manuscript, Juan Lado collected and analyzed data and wrote the manuscript, Stephanie Givler collected data, and Diva D. De Leon designed study and edited the manuscript.
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Hawkes, C.P., Lado, J.J., Givler, S., De Leon, D.D. (2018). The Effect of Continuous Intravenous Glucagon on Glucose Requirements in Infants with Congenital Hyperinsulinism. In: Morava, E., Baumgartner, M., Patterson, M., Rahman, S., Zschocke, J., Peters, V. (eds) JIMD Reports, Volume 45. JIMD Reports, vol 45. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8904_2018_140
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DOI: https://doi.org/10.1007/8904_2018_140
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