Glucagon Dosing for Food Impaction
The recommended dose of glucagon for treating esophageal food impaction is 1 mg administered intravenously over 5 minutes in adults. 1
Dosing Guidelines
Adult Dosing
- Standard dose: 1 mg IV administered over 5 minutes 1
- May be repeated or followed by an infusion of 5-15 μg/minute if needed 2
- Alternative administration routes if IV access is unavailable:
Pediatric Dosing
- Children: 20-30 μg/kg with a maximum of 1 mg 2
- For children weighing less than 44 lb (20 kg): 0.5 mg or dose equivalent to 20-30 μg/kg 3
Clinical Considerations
Efficacy
- Glucagon has a relatively low success rate (14-33%) for food impaction resolution 4, 5
- Most effective when:
Administration Pearls
- Reconstitute glucagon powder with provided diluent immediately before use 1
- Solution should be clear and colorless; do not use if cloudy or contains particles 1
- Discard any unused portion after administration 1
- Monitor for potential side effects, particularly vomiting (occurs in ~12.6% of patients) 4
Adjunctive Measures
- Some evidence suggests combining glucagon with:
Important Caveats
- Endoscopic removal remains the definitive treatment for food impaction when glucagon fails
- Approximately 67-84% of patients who fail glucagon therapy will require endoscopic intervention 4, 5
- Avoid using glucagon in patients with:
- Suspected complete esophageal obstruction
- Symptoms lasting >24 hours
- Signs of esophageal perforation
Follow-up Care
- After successful resolution of food impaction:
- Provide oral carbohydrates to restore liver glycogen and prevent hypoglycemia 1
- Consider endoscopic evaluation to identify underlying esophageal pathology
- Evaluate for conditions commonly associated with food impaction (eosinophilic esophagitis, esophageal rings, strictures)
While glucagon is commonly used for food impaction, clinicians should be prepared for its limited efficacy and have endoscopic resources available when administering this treatment.