Rectal D50

[emtjack02]

So the statement that glucagon will not work isn't entirely accurate...the route is the problem. If one was to give it nasally it should still work.

 

[reaper]

It might work fine nasally, but I have never seen a protocol that allows it to be given nasally. Anyone out there have one?

 

[emtjack02]

Ours does. Also, diazepam, Versed, narcan, morphine.

 

[reaper]

Morphine nasally? I would like to see your protocols, if they are online?

 

[GonnaBeEMT]

Would IO administration be out of the question?

 

[emtjack02]

Sorry, they are not online. I can try to answer any questions for you.
IO: I dont' believe would be totally out of line if we're considering intranasal glucagon. I would probably be more apt to use IO if the pt was in a shock type state.

 

[Dobby]

This is not dobby but another paramedic looking over her shoulderh34r:. Glucogon is awesome and will work in most cases. If it does not and IVI access is not available I would rather insert a NG tube and keep the pt lateral. Then place Dex 50% down the tube (keep suction handy). Bucal application of glucogel will also give you some time. Not sure i want to go down THERE!! Please referance research to the administration of dextrose rectally and its efficacy. This does sound interisting and I have no evidence to discredit it and have not heard about it, but if i dont have to "drop em" I wont.:blush:

 

[mycrofft]

Hyperosmotic solution to the lower GI tract causes diarreah.

Any questions?

 

[JPINFV]

Sure, I've got a question for you. Which is worse, diarrhea or dead brain cells?

 

[WiFi_Cowgirl]

I dunno, I'm not a fan of anything that involves the word Rectal, or inserting anything into said Rectum.

 

[JPINFV]

While I'm all for the anus being a one way road, in an emergency even one way roads can be utilized 'against traffic.'

 

[mikeylikesit]

ideally nasally should work do to the amount of mucous membranes in that route!

 

[Emtgirl21]

We have protocols for nasal administeration of versed.

 

[maxwell]

I am new here, and have been active in another ems forum. Recently a question was posted about the use of Glucagon in the hypoglycemic patient that you can not get IV access for. The question was about what you should do next, if glucagon doesnt work ?

I was shocked to realize that most new medics did not know that D50 can be given orally (but soda is better -- a 12oz coke has 39 gms of sugar versus 25 gms in D50), and that D50 can be given rectally via an ETT tube.

Thought I would share the info in case some in this forum were not aware.

Absolutely not. Rectal D50? Zero rationale. Sorry. I mean, you can give anything rectally. Rectal valium I understand for infantile seizures that require tx. But D50? A hypertonic, viscous, nasty drug? Just give glucagon IM! If you're ja pressed to get access, go I/O and give the dextrose through there. No reason for rectal D50. I'd venture to say it's stupid. Just repeat the glucagon!

My favorite saying goes as follows:
"It's not that the medicine doesn't work, it's that you're not giving enough of it."

 

[medic417]

Absolutely not. Rectal D50? Zero rationale. Sorry. I mean, you can give anything rectally. Rectal valium I understand for infantile seizures that require tx. But D50? A hypertonic, viscous, nasty drug? Just give glucagon IM! If you're ja pressed to get access, go I/O and give the dextrose through there. No reason for rectal D50. I'd venture to say it's stupid. Just repeat the glucagon!

My favorite saying goes as follows:
"It's not that the medicine doesn't work, it's that you're not giving enough of it."

And if you were going rectal use oral glucose as it actually has more sugar than D-50 and is thicker so more likely to have time to be absorbed, rather than oozing out.

 

[maxwell]

Or don't give anything rectally! But yes, with respect to concentration - PO glucose is much more concentrated.

 

[reaper]

Rectal D50 has been around for ever. It is another way to administer it.

You can give all the Glucagon you want, when the stores run out, it will not work and the pt will crash hard!

 

[GonnaBeEMT]

I agree with you.... What is with all the butt bandits on here? lol

Absolutely not. Rectal D50? Zero rationale. Sorry. I mean, you can give anything rectally. Rectal valium I understand for infantile seizures that require tx. But D50? A hypertonic, viscous, nasty drug? Just give glucagon IM! If you're ja pressed to get access, go I/O and give the dextrose through there. No reason for rectal D50. I'd venture to say it's stupid. Just repeat the glucagon!

My favorite saying goes as follows:
"It's not that the medicine doesn't work, it's that you're not giving enough of it."

 

[rmellish]

You can give all the Glucagon you want, when the stores run out, it will not work and the pt will crash hard!

Exactly, some folks tend to forget that.

 

[maxwell]

Exactly, some folks tend to forget that.

I remember this quite well. If you're worried :glare: about this (for example, for patients who have recently recieved a lot of epinephrine - recall epi breaks down hepatic glycogen) - push 50 g of 50% Dextrose IO!