From the Guidelines
The recommended dosage for intramuscular (IM) glucagon is 0.03 mg/kg up to a maximum of 1 mg, which can be repeated every 15 minutes up to a total of 3 doses if needed for clinical effect. This dosage is based on the study published in Pediatrics in 2008 1. The study provides guidance on the dosage of glucagon for hypoglycemia caused by insulin excess, which is a common indication for glucagon administration.
Key Considerations
- The dosage of 0.03 mg/kg up to a maximum of 1 mg is recommended for IM administration, with the option to repeat the dose every 15 minutes up to a total of 3 doses if needed.
- It is essential to follow the manufacturer's instructions for reconstituting glucagon, as it is unstable in solution.
- After administration, the patient should be monitored for clinical effect and potential side effects, such as nausea and vomiting.
- Once the patient regains consciousness, oral carbohydrates should be given to restore liver glycogen stores and prevent recurrence of hypoglycemia.
Administration and Monitoring
- Glucagon should be administered into a large muscle, such as the thigh, buttock, or upper arm.
- The patient should be turned onto their side to prevent aspiration if vomiting occurs.
- The effect of glucagon is temporary, lasting about 1-2 hours, which is why follow-up with oral carbohydrates is essential. Another study published in the same year, also in Pediatrics, provides different dosage recommendations 1, however, the study published with reference_id 1 provides more specific guidance on the dosage for hypoglycemia, which is the primary indication for glucagon administration.
From the FDA Drug Label
The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously Pediatric Patients Weighing Less Than 25 kg or for Pediatric Patients with Unknown Weight Less Than 6 Years of Age The recommended dosage is 0.5 mg (0. 5 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously. The recommended diagnostic dose for relaxation of the stomach, duodenal bulb, duodenum, and small bowel is 0.2 mg to 0.5 mg administered intravenously or 1 mg administered intramuscularly; the recommended dose to relax the colon is 0.5 mg to 0. 75 mg administered intravenously or 1 mg to 2 mg administered intramuscularly
The recommended dosage for IM glucagon is:
- 1 mg (1 mL) for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older
- 0.5 mg (0.5 mL) for pediatric patients weighing less than 25 kg or for pediatric patients with unknown weight less than 6 years of age
- 1 mg for diagnostic use to relax the stomach, duodenal bulb, duodenum, and small bowel
- 1 mg to 2 mg for diagnostic use to relax the colon 2
From the Research
Dosage for IM Glucagon
- The recommended dosage for intramuscular (IM) glucagon is 1mg, administered into the right thigh 3.
- This dosage is commonly used in the treatment of severe hypoglycemia, particularly in situations where intravenous access is not available 3, 4.
- Studies have shown that IM glucagon is effective in increasing blood glucose levels, although the response may be slightly slower and less predictable compared to intravenous dextrose 3, 4.
- The pharmacokinetics and bioavailability of IM glucagon have been studied, and it has been found to be similar to subcutaneous administration, with no significant difference in blood glucose behavior 4.
- It is worth noting that while IM glucagon is effective, newer formulations such as intranasal glucagon may offer advantages in terms of ease of use and administration 5, 6, 7.