Glucagon (Systemic)


VA CLASSIFICATION
Primary: HS508
Secondary: AD900; DX900; GA801

Commonly used brand name(s): Glucagon Diagnostic Kit; Glucagon Emergency Kit; Glucagon Emergency Kit for Low Blood Sugar.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Antihypoglycemic—

diagnostic aid adjunct (antispasmodic)—

antispasmodic—

antidote (to beta-adrenergic blocking agents; to calcium channel blocking agents)—

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

Hypoglycemia (treatment)—Glucagon is indicated in the correction of severe hypoglycemic conditions. {03} {05} {15} {16} {24} {25} {33} {34} {35} {60} {61} {78} Its efficacy is dependent upon the availability of glycogen in the liver. {03} {15} {16} {24} {31} Glucagon may be used together with glucose without decreasing the effects of either, {25} {31} such as in patients in a very deep state of coma (e.g., Stage IV or Stage V of Himwich) in which intravenous glucose is given in addition to glucagon for a more immediate response. {31}

Radiography, gastrointestinal, adjunct—Glucagon is indicated in barium radiographic examinations to produce hypotonicity and relaxation of the esophagus, stomach, duodenum, small bowel, and colon. {03} {15} {16} {24} {27} {31} {32} {61} {64} {65} {66} {67} {70} {71} {72} {73} {74} {75} {78} Glucagon is administered to provide relaxation of smooth musculature, and to decrease peristalsis, thereby reducing patient discomfort, slowing emptying, and improving the examination quality. {24} {27} {31} {32} {36} {61} {64} {65} {66} {67} {70} {71} {72} {73} {74} {75} {84}

[Abdominal imaging, digital angiographic, adjunct]1or
[Abdominal imaging, computed tomographic (CT), adjunct]1or
[Abdominal imaging, magnetic resonance, adjunct]1or
[Pelvic imaging, magnetic resonance, adjunct]1—Glucagon is indicated to inhibit bowel peristalsis in abdominal digital vascular imaging, abdominal and pelvic magnetic resonance imaging, and in abdominal CT scanning to prevent motion-related artifact. {27} {31} {36} {38} {39} {83}

[Bleeding, gastrointestinal (diagnosis adjunct)]1—Glucagon may be beneficial as an adjuvant to Tc 99m–labeled red blood cells in the scintigraphic diagnosis of small bowel hemorrhage. {77}

[Hysterosalpingography, adjunct]1—Glucagon is used rarely by some clinicians to eliminate possible spasm of the fallopian tubes during hysterosalpingography in those patients whose fallopian tubes are not visualized during examination. {40} {41} {42} {43} {44} {45} {46} {84} {85}

[Toxicity, beta-adrenergic blocking agent (treatment)]1—Glucagon administered in large intravenous doses is indicated to treat the cardiotoxic effects, specifically bradycardia and hypotension, in overdoses of beta-adrenergic blocking agents. {06} {07} {08} {09} {10} {11} {12} {13} {14} {22} {24} {31} {59} Glucagon may be used with isoproterenol or dobutamine. {31} Supplemental potassium may be necessary for treated patients since glucagon tends to reduce serum potassium.

[Toxicity, calcium channel blocking agent (treatment)]1—Glucagon is indicated in the treatment of myocardial depression caused by calcium channel blocking agents in those patients in whom conventional therapies have been ineffective. {48} {49} {56} {57} {58} {59} {83}

[Esophageal obstruction, foreign body (treatment)]1—Glucagon is indicated in the treatment of lower esophageal obstruction due to foreign bodies, including food boluses. {37} {48} {49} {50} {59} {61} {79} {83}

Unaccepted
Glucagon is of little or no help in the treatment of hypoglycemia in conditions in which hepatic glycogen stores are depleted, such as starvation, adrenal insufficiency, or chronic hypoglycemia. {03} {15} {16} {24} {31} {47}

Glucagon should not be used to treat birth asphyxia or hypoglycemia in premature infants or in infants who have had intrauterine growth retardation.

Glucagon has been used as an aid in the diagnosis of insulinoma and pheochromocytoma; {31} {32} however, USP advisory panels do not generally recommend glucagon for this use because of questions about safety. {31} {32} {81}

1 Not included in Canadian product labeling.



Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Source—
    Animal origin: Beef or pork pancreas. {03} {17}
    Recombinant DNA (rDNA) origin: Synthesized using rDNA process involving genetically altered Escherichia coli. {15}

Chemical group—
    Glucagon is a single-chain polypeptide containing 29 amino acid residues. {03} {15} {17} {31} It is chemically unrelated to insulin. {03} {17} One USP Unit of glucagon is equivalent to 1 International Unit of glucagon and to 1 mg of glucagon. {03} {15}
Molecular weight—
    3482.82 {02}


pH
    Reconstituted solution (animal origin): 2.5 to 3. {01}

Mechanism of action/Effect:

Promotes hepatic glycogenolysis and gluconeogenesis. {24} {28} {31} {32} Stimulates adenylate cyclase to produce increased cyclic adenosine monophosphate (cAMP), which is involved in a series of enzymatic activities. {22} {31} {32} {59} The resultant effects are increased concentrations of plasma glucose, a relaxant effect on smooth musculature, and a positive chronotropic and inotropic myocardial effect. {03} {15} {16} {24} {27} {28} {31} {59} Hepatic stores of glycogen are necessary for glucagon to elicit an antihypoglycemic effect. {03} {15} {16} {24} {28} {31} {59}

Distribution:

Vol D—0.25 L per kg of body weight. {15}

Biotransformation:

Primarily hepatic and renal through enzymatic proteolysis. {24} {31} {61}

Half-life:


In plasma:

Animal origin: 3 to 6 minutes. {03} {16}

rDNA origin: 8 to 18 minutes. {15}


Onset of action:


Antihypoglycemic action:

Intravenous: 5 to 20 {74} minutes. {61}

Intramuscular: 15 {61} to 26 {15} minutes.

Subcutaneous: 30 to 45 minutes. {15} {61}



Smooth muscle relaxation:


Intravenous—

0.25 to 2 USP Units—45 seconds {74} {75} to 1 minute {15} {16}.



Intramuscular—

1 USP Unit—8 to 10 minutes. {03} {15} {16} {31} {64} {74}

2 USP Units—4 to 7 minutes. {03} {16} {15}



Time to peak plasma concentration

Intramuscular—13 minutes. {15}

Subcutaneous—20 minutes. {15}

Peak plasma concentration

Intramuscular—6.9 nanograms per mL (nanograms/mL). {15}

Subcutaneous—7.9 nanograms/mL. {15}

Duration of action:


Antihypoglycemic action:

90 minutes. {61}



Smooth muscle relaxation:


Intravenous—

0.25 to 0.5 USP Units—9 to 17 minutes. {03} {15} {16} {74} {77}

2 USP Units—22 to 25 minutes. {03} {15} {16} {27} {77}



Intramuscular—

1 USP Unit—12 to 27 minutes. {03} {15} {16} {27} {64} {74} {77}

2 USP Units—21 to 32 minutes. {03} {15} {16} {27} {77}




Precautions to Consider

Cross-sensitivity and/or related problems

Patients who are allergic to beef or pork proteins may be allergic to animal origin glucagon.

Carcinogenicity

Studies to determine the carcinogenic potential of glucagon have not been done. {03} {15}

Mutagenicity

The increase in colony counts found with the Ames assay was attributed to difficulties in performing the assay with peptides and not to the mutagenic activity of glucagon. {15}

Pregnancy/Reproduction
Fertility—
Studies in rats administered glucagon at doses of up to 2 mg per kg of body weight (mg/kg) two times a day {03} {15} (up to 40 times the human dose based on body surface area) {15} have not shown that glucagon causes impaired fertility. {03} {15}

Pregnancy—
Adequate and well-controlled studies in humans have not been done. {03} {15} {16}

Studies in rats administered glucagon at doses of up to 2 mg/kg two times a day {03} {15} {16} (up to 40 times the human dose based on body surface area) {15} have not shown that glucagon causes adverse effects in the fetus. {03} {15} {16}

FDA Pregnancy Category B. {03} {15}

Breast-feeding

It is not known whether glucagon is distributed into breast milk. {03} {15} {16} However, problems in humans have not been documented. Because glucagon is inactivated by gastric acid, problems are unlikely. {03} {15} {16} Also, glucagon has a short half-life and generally is used only for a short time. {03}

Pediatrics

Appropriate studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of glucagon in children. {03} {15} {79}


Geriatrics


Appropriate studies on the relationship of age to the effects of glucagon have not been performed in the geriatric population. However, geriatrics-specific problems that would limit the usefulness of this medication in the elderly are not expected. {26}

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

Anticoagulants, coumarin- or indandione-derivative{31}{78}    (concurrent use with glucagon may potentiate the anticoagulant effects; {31} {78} enhanced anticoagulant activity has been reported with unusually high doses of glucagon such as 25 mg or more per day for 2 or more days {78})


Beta-adrenergic blocking agents{03}{15}{16}    (the transient increases in blood pressure and pulse rate caused by glucagon may be more pronounced with concurrent use {03} {15} {16})



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With physiology/laboratory test values
Blood pressure{03}{15}{16} and
Pulse rate{03}{15}{16}    (transient increases may occur {03} {15} {16})


Potassium{03}{15}{16}{24}{59}    (serum concentrations may be decreased with use of large doses {03} {15} {16} {24})


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Risk-benefit should be considered when the following medical problems exist
Allergy to beef or pork proteins, history of{79}
» Insulinoma, or history of{03}{15}{16}{24}{31}{59}{61}{65}{69}{79}    (blood glucose concentrations may be decreased as a result of insulin released by the insulinoma in response to glucagon's antihypoglycemic effect {03} {15} {16})


» Pheochromocytoma{03}{15}{16}{24}{31}{32}{59}{61}{65}{68}{69}{79}    (increased risk of hypertension due to stimulation of the release of catecholamines {03} {15} {16} {24} {31} {32} {61} {68} {69})


Sensitivity to glucagon
For use as a diagnostic aid adjunct (in addition to those listed above):
» Diabetes mellitus{24}{65}{74}    (increased risk of hyperglycemia {24} {74})



Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):


For treatment of hypoglycemia
Blood glucose determinations{03}{15}{16}    (recommended every 15 minutes until blood glucose concentrations return to normal, {23} then hourly for an additional 3 to 4 hours {80} {82})


For treatment of calcium channel blocking agent toxicity
Calcium, total{59} and
Calcium, total ionized{59}    (recommended to determine efficacy; failure of glucagon therapy may be associated with hypocalcemia and hypercalcemia {59})




Side/Adverse Effects
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence less frequent
    
Allergic reaction (dizziness; lightheadedness; skin rash; trouble in breathing){03}{15}{16}{24}{61}



Those indicating need for medical attention only if they continue or are bothersome
Incidence less frequent or rare
    
Fast heartbeat {15}
    
nausea {03}{15}{16}{24}{27}{31}{59}{61}{65}{74}{79}
    
vomiting {03}{15}{16}{22}{24}{27}{31}{59}{61}{65}{74}{79}

Note: The incidence of nausea and vomiting is generally dependent upon dose (it is higher with the 2-mg dose than with lower doses) {03} {15} {16} and, with intravenous use, the rate of injection; these effects may be diminished by slower intravenous administration. {22} {31} {61} {80} {81}






Overdose
For specific information on the agents used in the management of glucagon overdose, see:    • Phentolamine (Systemic)monograph; and/or
   • Potassium Supplements (Systemic) monograph.


For more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ).

Clinical effects of overdose (in order of usual occurrence {50})
The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
    
Continuing nausea {03}{15}{16}
    
continuing vomiting {03}{15}{16}
    
diarrhea {03}{15}{16}
    
gastric hypotonicity {03}{15}{16}
    
hypertension {03}{15}{16}
    
hypokalemic syndrome (severe weakness of extremities and trunk; loss of appetite; nausea; vomiting; irregular heartbeat; muscle cramps or pain){03}{31}


Treatment of overdose
Due to the short half-life of glucagon, treatment of glucagon overdose is primarily symptomatic and supportive. {03} {15} {16} Also, because it is a polypeptide, glucagon would be destroyed rapidly in the gastrointestinal tract if it were unintentionally ingested. {03} {15} {16}

Specific treatment—Treating hypokalemia with potassium supplementation and hypertension with phentolamine. {03} {15} {16}

Monitoring—Monitoring of serum electrolytes, especially potassium; {03} {31} monitoring blood glucose concentrations {31} and blood pressure. {31}

Supportive care—Replacing fluids as necessary, due to excessive nausea and vomiting. Patients in whom intentional overdose is confirmed or suspected should be referred for psychiatric consultation.


Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Glucagon (Systemic) .

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to glucagon
Other medical problems, especially diabetes mellitus (for diagnostic procedures only), insulinoma or history of, or pheochromocytoma

Proper use of this medication
» Using medication only as directed by physician; explaining proper use to family member or friend; reviewing use on a regular basis {51} {55}

» Reading directions in glucagon kit before medication is actually needed; knowing how to reconstitute and inject properly

» Not keeping after expiration date on vial; checking date regularly; replacing medication before it expires; discarding unused portion after mixing

» Proper dosing

Proper storage

Precautions while using this medication
» Recognizing what brings on symptoms of hypoglycemia, such as using too much insulin or oral antidiabetic medication; delaying or missing a meal or snack; illness, especially vomiting or diarrhea; and exercising more than usual

» Recognizing early symptoms of hypoglycemia: anxiety, behavior change similar to drunkenness, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness and weakness; unless corrected, will lead to unconsciousness, seizures, and possibly death

Being aware that symptoms of hypoglycemia vary among individuals; learning to recognize own symptoms; checking blood sugar if hypoglycemia is suspected

» Knowing what to do if symptoms of mild hypoglycemia occur: eating glucose tablets or gel, corn syrup, honey, or sugar cubes; drinking fruit juice, nondiet soft drink, or sugar dissolved in water; {05} also eating a small snack, such as crackers and cheese, half a sandwich, or drinking a glass of milk when scheduled meal is longer than 1 hour away; not eating hard candy or mints because the sugar does not get into the blood stream quickly enough; {29} not eating foods high in fat, such as chocolate, because fat slows gastric emptying; checking blood sugar after 10 to 20 minutes {30}

» Going to the doctor or hospital immediately if symptoms do not improve after eating or drinking a source of sugar

» Administering glucagon and calling the patient's physician if seizures or unconsciousness occurs; preventing choking by not forcing the patient to eat or drink anything

Steps to be taken after glucagon is injected for hypoglycemia
» After the injection, turning the patient onto the left {19} side to prevent choking if vomiting occurs {05}

» If the patient does not regain consciousness within 15 minutes, giving second dose; simultaneously, getting emergency help {05} {15} {76}

When the patient is conscious enough to swallow, initially giving some form of sugar to take orally, then having patient eat crackers and cheese or half a sandwich or drink a glass of milk to prevent hypoglycemia from recurring before the next scheduled meal or snack {05}

Monitoring blood glucose concentrations throughout episode, treatment, and hourly for 3 to 4 hours after the patient regains consciousness {80} {82}

» If nausea and vomiting prevent the patient from swallowing some form of sugar for an hour after injection, getting medical assistance
» Keeping physician informed of hypoglycemic episodes and use of glucagon {05} {15} {16}

» Replacing supply of glucagon as soon as possible

At all times wearing medical identification and carrying identification card that lists medical condition and medications


Side/adverse effects
Signs of potential side effects, especially allergic reaction


General Dosing Information
Glucagon should not be used in concentrations greater than 1 USP Unit (1 mg) per mL. {03} {15} {16}

For use as an antihypoglycemic
Prior to the administration of glucagon, a rapid blood glucose test should be performed to confirm that the patient has low blood sugar. {52} A physician should be contacted at the time of glucagon administration. {18} Blood glucose should also be monitored throughout the hypoglycemic episode, treatment period, and for 3 to 4 hours after the patient regains consciousness. {80} {82}

Patient response usually occurs within 15 minutes after administration of glucagon. {03} {15} {16} An additional dose may be given if no response is evident within this time. {03} {15} {16} Medical care will be needed if response is not obtained following a second glucagon injection; intravenous glucose will be required if the patient fails to respond to glucagon. {03} {15} {16}

After the patient is sufficiently alert and oriented, oral supplemental sugar (glucose or sucrose) must be given to prevent secondary hypoglycemia. {03} {15} {16} {31} Patients with type 1 diabetes have less of an increase in blood glucose concentration than do patients with stable type 2 diabetes. {03} {15} {16} {31} Therefore, it is especially important that supplemental carbohydrates be given as soon as possible to patients with type 1 diabetes. {03} {15} {16} Emergency room evaluation and/or hospital admission should be considered for all patients experiencing a hypoglycemic episode from oral antidiabetic agents (especially chlorpropamide), since hypoglycemia may recur after blood glucose concentrations are normalized. {76}

If nausea and vomiting result from glucagon administration and the patient is unable to ingest some form of sugar for 1 hour, medical assistance should be obtained immediately. Severe hypoglycemia may rapidly recur in these circumstances.


Parenteral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

One mg of glucagon is equivalent to 1 USP Unit of glucagon and to 1 International Unit (IU) of glucagon. {15}

GLUCAGON FOR INJECTION (ANIMAL ORIGIN) USP

Usual adult and adolescent dose
Hypoglycemia
Intramuscular, intravenous, or subcutaneous, 1 mg, repeated after fifteen minutes if necessary. {03} {16}

Radiography, gastrointestinal or
[Abdominal imaging, digital angiographic]1 or
[Abdominal imaging, computed tomographic or magnetic resonance]1 or
[Pelvic imaging, magnetic resonance]1 or
[Hysterosalpingography]1
Intravenous, 0.25 to 2 mg. {03} {16}

Note: For examination of the colon, the dose should be administered intramuscularly approximately ten minutes prior to the procedure. {03} {15} {16}
Doses in the upper range and/or intramuscular administration may be preferred by some clinicians to achieve hypotonicity during the prolonged scan times associated with magnetic resonance imaging. {81} {86} The duration of action of glucagon is longer with intramuscular administration. {81}


[Toxicity, beta-adrenergic blocking agent]1
Intravenous, initially, 50 to 150 mcg (0.05 to 0.15 mg) per kg of body weight over one minute, to be followed by a 1- to 5-mg-per-hour infusion. {48} {59} {83}

[Toxicity, calcium channel blocking agent]1
Intravenous, initially 2 mg. {57} {83} Maintenance dosing is then titrated according to patient response.

[Esophageal obstruction due to foreign body]1
Intravenous, 0.5 to 2 mg, repeated after ten to twenty minutes if necessary. {37} {79} {83}


Usual pediatric dose
Hypoglycemia


For patients weighing up to 20 kg:
Intramuscular, intravenous, or subcutaneous: 0.5 mg or 20 to 30 mcg (0.02 to 0.03 mg) per kg of body weight, repeated after fifteen minutes if necessary. {03} {16}



For patients weighing 20 kg or over:
See Usual adult and adolescent dose . {03} {16}



Usual geriatric dose
See Usual adult and adolescent dose .

Size(s) usually available:
U.S.—


1 mg (1 USP Unit) (Rx) [Glucagon Emergency Kit (lactose 49 mg){03}][Generic]{03}

Canada—


1 mg (1 USP Unit) (Rx) [Glucagon Emergency Kit (lactose 49 mg){16}{17}][Generic]{17}

Packaging and storage:
Prior to reconstitution, store between 15 and 30 °C (59 and 86 °F), {03} {16} {17} unless otherwise specified by manufacturer.

Preparation of dosage form:
The entire contents of the diluent-filled syringe should be injected into the vial of glucagon. The vial then should be swirled gently until the glucagon is dissolved completely. {03}

Stability:
Glucagon should be used immediately after it is reconstituted. Any unused solution should be discarded. {03} {16} {17}

Incompatibilities:
Glucagon may precipitate from saline solution and solutions having a pH of 3 to 9.5.

Auxiliary labeling:
   • Discard unused portion.

Note: Make sure patient understands use of syringe supplied with kit.
Check patient's understanding of preparing and administering medication.
Make sure patient routinely checks expiration date of medication.



GLUCAGON FOR INJECTION (RECOMBINANT)

Usual adult and adolescent dose
See Glucagon for Injection USP (Animal Origin) . {21}

Usual pediatric dose
See Glucagon for Injection USP (Animal Origin) . {21}

Usual geriatric dose
See Glucagon for Injection USP (Animal Origin) . {21}

Size(s) usually available:
U.S.—


1 mg (1 USP Unit) (Rx) [Glucagon Diagnostic Kit (lactose 49 mg){15}] [Glucagon Emergency Kit for Low Blood Sugar (lactose 49 mg){15}]

Canada—
Not commercially available. {04}

Packaging and storage:
Prior to reconstitution, store between 15 and 30 °C (59 and 86 °F), {15} unless otherwise specified by manufacturer.

Preparation of dosage form:
The entire contents of the diluent-filled syringe should be injected into the vial of glucagon. The vial then should be swirled gently until the glucagon is dissolved completely. {15}

Stability:
Glucagon should be used immediately after it is reconstituted. Any unused solution should be discarded. {15}

Incompatibilities:
Glucagon may precipitate from solutions having a pH of 3 to 9.5. {15}

Auxiliary labeling:
   • Discard unused portion.

Note: Make sure patient understands use of syringe supplied with kit.
Check patient's understanding of preparing and administering medication.
Make sure patient routinely checks expiration date of medication.




Revised: 01/29/1999



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  1. Panel comment, 4/30/91.
  1. Panel comment, 4/30/91.
  1. Panel comment, 4/30/91.
  1. Not used.
  1. Not used.
  1. Panel comment, 4/30/91.
  1. Jolly SR, Kipnis JN, Lucchesi BR. Cardiovascular depression by verapamil: reversal by glucagon and interactions with propranolol. Pharmacology 1987; 35: 249-55.
  1. Linden CH, Aghababian RV. Further uses of glucagon [letter]. Crit Care Med 1985; 13(4): 248.
  1. Zaritsky AL, Horowitz M, Chernow B. Glucagon antagonism of calcium channel blocker-induced myocardial dysfunction. Crit Care Med 1988; 16(3): 246-51.
  1. Ellenhorn MJ. Ellenhorn's medical toxicology: diagnosis and treatment of human poisoning. 2nd ed. Baltimore: Williams & Wilkins; 1997. p. 98-99, 526-7, 538-9.
  1. Panel comment, 4/30/91.
  1. Vukmir RB, Paris PM, Yealy DM. Glucagon: prehospital therapy for hypoglycemia. Ann Emerg Med 1991; 20(4): 375-9.
  1. Not used.
  1. Not used.
  1. Miller RE, Chernish SM, Brunelle RL, et al. Dose response to intramuscular glucagon during hypotonic radiography. Radiology 1978; 127: 49-53.
  1. Thoeni RF, Vandeman F, Wall SD. Effect of glucagon on the diagnostic accuracy of double-contrast barium enema examinations. AJR 1984; 142: 111-4.
  1. Violon D, Steppe R, Potvliege R. Improved retrograde ileography with glucagon. AJR 1981; 136: 833-4.
  1. Rothe AJ, Young JWR, Keramati B. The value of glucagon in routine barium investigations of the gastrointestinal tract. Invest Radiol 1987; 22: 786-91.
  1. McLaughlin MJ, Langer B, Wilson DR. Life-threatening reaction of glucagon in a patient with pheochromocytoma [letter]. Radiology 1981; 40(3): 841-2.
  1. Miller RE, Chernish SM. Life-threatening reaction of glucagon in a patient with pheochromocytoma [reply]. Radiology 1981; 40(3): 842.
  1. Thoeni RF, Margulis AR. The state of radiographic technique in the examination of the colon: a survey in 1987. Radiology 1988; 167: 7-12.
  1. Monsein LM, Halpert LH, Harris ED, et al. Retrograde ileography value of glucagon. Radiology 1986; 161: 558-9.
  1. Heron CW, et al. A comparison of paralysing agents in double-contrast barium meal examinations. Clin Radiol 1985; 36(4): 391-3.
  1. Miller RE, et al. Gastrointestinal response to minute doses of glucagon. Radiology 1982; 143(2): 317-20.
  1. Miller RE, Chernish SM, Brinella RL. Gastrointestinal radiology with glucagon. Gastrointest Radiol 1979; 4(1): 1-10.
  1. Miller RE, et al. Double-blind radiographic study of dose response to intravenous glucagon for hypotonic duodenography. Radiology 1978; 127(1): 55-9.
  1. Panel comment, 9/10/91.
  1. Froelich JW, Juni J. Glucagon in the scintigraphic diagnosis of small-bowel hemorrhage by TC-99m–labeled red blood cells. Radiology 1984; 151: 239-42.
  1. Koch-Weser J. Potentiation by glucagon of the hypoprothombinemic action of warfarin. Ann Intern Med 1970; 72: 331-5.
  1. Mandell GA, Teplick SK. Glucagon: its application to childhood gastrointestinal radiology. Gastrointest Radiol 1982; 7: 7-13.
  1. Panel comment, 9/10/91.
  1. Panel comment, 9/10/91.
  1. Panel comment, 9/10/91.
  1. Reviewers' consensus on monograph revision of 9/10/91.
  1. Panel comment, 9/10/91.
  1. Panel comment, 9/10/91.
  1. Panel comment, 9/10/91.
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