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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, January 3, 2017

Glucagon for Food Boluses

R.E.B.E.L.EM - January 2, 2016 - By Salim Rezaie
"Background: How many of you have had this scenario…patient comes into ED, just ate a big steak and now they can’t swallow. You call gastroenterology, who asks… “Did you try glucagon yet?” OK, well maybe not exactly like that, but you get what I am asking. Esophageal foreign body impactions are a rare entity, that cause quite a bit of discomfort to patients and have the potential for esophageal necrosis and perforation. The definitive treatment for removal is endoscopy with direct visualization and removal of the object causing the obstruction. This procedure is invasive, time consuming, requires a gastroenterologist, as well as procedural sedation. Due to the time it takes to set up for this procedure, many consultants will ask to try medical therapy first. There are several options including carbonated beverages, calcium channel blockers, sublingual nitroglycerin, proteolytic enzymes, benzodiazepines, and last but not least intravenous glucagon. This review will focus on the use of glucagon for esophageal foreign bodies....
Clinical Take Home Point: Given the weak evidence for the benefits of glucagon, the potential side effect of nausea/vomiting, and the fact that nearly 1/4th of patients will have an anatomic etiology to their obstruction, avoid the use of glucagon and consult your local gastroenterologist instead."