Hypoglycaemia: Intravenous glucose produced a quicker return to consciousness than intramuscular glucagon

Clinical bottom line (level 1b-)

  1. In patients presenting to A+E with hypoglycaemic coma, intravenous glucose led to a quicker recovery than intramuscular glucagon (3 mins vs 9 mins median times)
  2. In patients arriving in A+E with hypoglycaemic coma, it is unclear as to whether i/m glucagon requires a clinically important increase in the chance of rescue dextrose being required (NNH = 8 at 15 minutes)
  3. In patients presenting to A+E in hypoglycaemic coma and given i/v glucose or i/m glucagon the median estimated total duration of coma was long, 120 mins.
Patrick et al: Archives of Emergency Medicine 1990; 7: 73-77
Expires August 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: teaching hospital accident and emergency department, UK

29 patients (aged mean 47years, 76% male) hypoglycaemic coma
Control Group: (n = 14, 14 analysed): intravenous glucose 25g (50ml of 50% dextrose)
Experimental Group: (n = 15, 15 analysed): intramuscular glucagon (1mg)

100% followed for ?

The evidence

Outcome Time to outcome CEREERARR
(95% CI)		NNH
(95% CI)
Requirement for additional dextrose after 15 mins without full recovery 15 minutes 0
(0%)		 2
(13%)		 -13%
(-30% to 3.8%)		 8
(NNT = 26 to infinity;
NNH = 3 to infinity)

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
time to achieve normal conscious levels (minutes) 3 (2-15)
() 		9 (5-30)
() 		6
( to )
estimated duration of hypoglycaemic coma (minutes) 120 ( 20 - 480)
() 		120 ( 60- 240)
() 		0
( to )

Comments

  1. Study demonstrates a quicker response of hypoglycaemic patients to i/m glucagon
  2. Insufficient patient numbers to assess side effects of either treatment
  3. There was insufficient power in the study to exclude a clinically important difference in the number of patients requiring 'rescue' dextrose

Citation

  1. Patrick AW, Collier A, Hepburn DA, et al: Comparison of intramuscular glucagon and intravenous glucose in the treatment of hypoglycaemic coma in an accident and emergency department. Archives of Emergency Medicine 1990; 7: 73-77
Contributor: Bob Phillips and Clare Wotton, August 1999
Reviewer:

Clinical Question.
Patient patients presenting with hypoglycaemic coma to A+E
Intervention or Exposure glucagon i/m
Comparison glucose 25g (50ml of 50% dextrose)
Outcome recovery to full consciousness