Haamid Ameera, Christian Errick, Tataris Katie, Markul Eddie, Zaidi Hashim Q, Mycyk Mark B, Weber Joseph M
Department of Emergency Medicine, Cook County Health, Chicago, Illinois.
Section of Emergency Medicine, University of Chicago, Chicago, Illinois.
Prehosp Emerg Care. 2023;27(3):356-359. doi: 10.1080/10903127.2022.2045406. Epub 2022 Mar 2.
Prehospital hypoglycemia is usually treated with oral or intravenous (IV) dextrose in a variety of concentrations. In the absence of vascular access, intramuscular (IM) glucagon is commonly administered. Occupational needle-stick injury remains a significant risk while attempting to obtain vascular access or administer medications intramuscularly in the prehospital setting. We sought to determine if intranasal (IN) glucagon is effective in the prehospital treatment of hypoglycemia.
We performed a retrospective analysis of all consecutive cases where recombinant glucagon was administered IN by paramedics from January 1, 2015 through December 31, 2020. Excluded were cases without pre or post administration blood glucose documentation, and cases where another form of treatment for hypoglycemia was administered at any time during the EMS encounter. The primary outcome was clinical response to IN glucagon documented by paramedics; secondary outcomes included pre and post administration blood glucose values.
Out of 44 cases that met study inclusion criteria, 14 patients (32%) had substantial improvement, 13 patients (30%) had slight improvement, and 17 patients (38%) had no improvement in mental status after administration of IN glucagon. In cases with substantial improvement (n = 14), the mean pre administration blood glucose was 33.8 mg/dl and the mean post administration blood glucose was 87.1 mg/dl (mean increase 53.3 mg/dl, 95% CI: 21.5 to 85.1). In cases with slight improvement (n = 13), the mean pre administration blood glucose was 23.9 mg/dl and the mean post administration blood glucose was 53.8 mg/dl (mean increase 29.9 mg/dl, 95% CI = 2.9 to 56.9). In case with no improvement (n = 17) the mean pre administration blood glucose was 30.1 mg/dl and the mean post administration glucose was 33.1 mg/dl (mean difference 3.1 mg/dl, 95% CI: -10.1 to 3.9).
Intranasal administration of recombinant glucagon for hypoglycemia resulted in a clinically significant improvement in mental status and a corresponding increase in blood glucose levels in select cases in the prehospital setting.
院前低血糖通常采用口服或静脉注射（IV）不同浓度的葡萄糖进行治疗。在无法建立血管通路的情况下，通常会肌内注射（IM）胰高血糖素。在院前环境中试图建立血管通路或进行肌内注射给药时，职业性针刺伤仍然是一个重大风险。我们试图确定鼻内（IN）给予胰高血糖素在院前低血糖治疗中是否有效。
我们对2015年1月1日至2020年12月31日期间护理人员经鼻给予重组胰高血糖素的所有连续病例进行了回顾性分析。排除了给药前后无血糖记录的病例，以及在急救医疗服务过程中任何时间接受过其他形式低血糖治疗的病例。主要结局是护理人员记录的对经鼻给予胰高血糖素的临床反应；次要结局包括给药前后的血糖值。
在符合研究纳入标准的44例病例中，14例患者（32%）有显著改善，13例患者（30%）有轻微改善，17例患者（38%）在经鼻给予胰高血糖素后精神状态无改善。在有显著改善的病例（n = 14）中，给药前平均血糖为33.8mg/dl，给药后平均血糖为87.1mg/dl（平均升高53.3mg/dl，95%可信区间：21.5至85.1）。在有轻微改善的病例（n = 13）中，给药前平均血糖为23.9mg/dl，给药后平均血糖为53.8mg/dl（平均升高29.9mg/dl，95%可信区间 = 2.9至56.9）。在无改善的病例（n = 17）中，给药前平均血糖为30.1mg/dl，给药后平均血糖为33.1mg/dl（平均差值3.1mg/dl，95%可信区间：-10.1至3.9）。
在院前环境中，经鼻给予重组胰高血糖素治疗低血糖在部分病例中导致精神状态有临床显著改善且血糖水平相应升高。
