From the Research
The recommended dose of intravenous glucagon for possible esophageal foreign body obstruction is 1 mg administered as a slow IV bolus. This medication can be used as a temporizing measure while preparing for endoscopy, which remains the definitive treatment for esophageal foreign body removal. Glucagon works by relaxing the smooth muscle of the esophagus, potentially allowing the impacted object to pass into the stomach. The onset of action is rapid, typically within 1-2 minutes, and the effect lasts about 15-20 minutes. Side effects may include nausea, vomiting, and rarely hypoglycemia. If the first dose is ineffective after 10 minutes, a second 1 mg dose may be administered, but further doses are unlikely to be beneficial. Glucagon is contraindicated in patients with pheochromocytoma and should be used cautiously in those with insulinoma or glucagonoma. This intervention is most effective for soft food impactions rather than sharp or large objects, and should not delay definitive endoscopic management when needed. According to the most recent and highest quality study 1, glucagon-related resolution of esophageal foreign body impaction occurred in 14.2% of patients, and was not significantly different compared with those that did not receive glucagon.
Key Points to Consider
- The effectiveness of glucagon in relieving esophageal foreign body impaction is relatively low, as shown in the study by 1.
- The use of glucagon does not offer advantages for treatment, and its administration was associated with adverse effects such as vomiting 1.
- Concomitant medication administration, such as benzodiazepine or nitroglycerin, was associated with lower success rates of glucagon 1.
- Endoscopy remains the definitive treatment for esophageal foreign body removal, and glucagon should not delay this management when needed.
- The recommended dose of 1 mg administered as a slow IV bolus is based on the study by 2, which used this dose in a prospective, double-blind, placebo-controlled trial.
Important Considerations for Patient Care
- Patients with pheochromocytoma should not receive glucagon due to the risk of adverse effects.
- Patients with insulinoma or glucagonoma should be cautious when receiving glucagon, as it may exacerbate their condition.
- The use of glucagon should be carefully considered in patients with sharp or large objects, as it may not be effective in these cases.
- Patients should be closely monitored for adverse effects, such as nausea, vomiting, and hypoglycemia, when receiving glucagon.