Management of Pediatric Medical Emergencies in the Dental Office
Glucagon

Glucagon, a hormone secreted by the pancreas, raises blood glucose levels. It has an effect opposite that of insulin which lowers blood glucose levels. The pancreas releases glucagon when blood sugar levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream. It is available in injectable form (Glucagen) for intramuscular administration.

A glucagon emergency kit contains a bottle of glucagon (dry powder) and a syringe of clear liquid (Figure 7).

The directions for use are:

• Remove the flip-off seal from the bottle of glucagon.
• Remove the needle protector from the syringe and inject the entire contents of the syringe into the bottle of glucagon.
• Remove the syringe and shake the bottle gently until the liquid is clear.
• Hold the bottle upside down, reinsert the needle and withdraw all of the solution from the bottle.
• For children under 44 lbs, give 0.5cc (1/2 the syringe) to start and then the remaining 0.5cc 20 minutes later.  (This reduces the chance of rebound hyperglycemia.)
• Older children and are given 1cc (the entire syringe).
• Give the injection in a large muscle such as the buttocks, thigh or arm (Figure 8).

• As glucagon can cause vomiting, place the patient on their side prior to the injection to prevent choking.
• When the patient regains consciousness and can swallow, give small sips of a carbohydrate fluid (fruit juice).
• If tolerated, follow with 15 grams of a carbohydrate and a fat containing food (crackers and cheese).