This is a 2 part question: 1) Can we effectively administer the newly Provincially Mandated IntraNasal Glucagon 3mg (we carry 2 of them at our service + 1 I/M 1mg Glucagon) to treat either a BetaBlocker or a Calcium Channel Blocker OD? 2) Can it be used in conjunction with IV Glucagon to be within the therapeutic range of efficacy. 

SWORBHP Medical Council would not suggest administering Intranasal Glucagon in the setting of beta blocker or calcium channel blocker overdose. 

Glucagon was traditionally considered a first line antidote for beta-blocker overdose. Historically, glucagon has also been used in the setting of calcium channel blocker toxicity. 

The use of glucagon as an antidote is rarely used for these reasons: 

• No proof of effectiveness 

• Hard to source the doses required 

• Commonly induces vomiting, with concomitant aspiration risk in the unprotected airway 

• Risk of distraction from the delivery of other therapies (e.g. high-dose insulin as an antidote or supportive measures) 

Glucagon administration in the setting of beta blocker overdose is recommended via the IV route. But, more importantly, expedient transport to hospital is required. Therefore, SWORBHP Medical Council would suggest initiating rapid transport and other supportive care via applicable Medical Directives (Symptomatic Bradycardia, Intravenous and Fluid Therapy). 

Hypoglycemia,Level of Consciousness

Beta Blocker, Bradycardia, glucagon, IntraNAsal, Intravenous, Overdose, Poisoning

Glucagon as an Antidote • LITFL • CCC Toxicology