The Safety of Glucagon use during ERCP in Diabetic Patients with Renal Insufficiency: A Case Discussion and Review of Literature

  • Lisa Erlinger, PhD, CRNA Midwestern University Wickenburg Community Hospital University of Missouri-Columbia
  • Terri Monk, MD, MS University of Missouri-Columbia
  • Steven McAfee, MD University of Missouri-Columbia

Abstract

This is a case report with the use of glucagon during ERCP which resulted in Hyperkalemia.  A 45 year old male, ASA 3, with Type 1 diabetes mellitus, hypertension, and chronic kidney disease underwent ERCP with general anesthesia for evaluation of a bile duct stricture.  After administration of 0.75 mg glucagon (0.25 mg doses over an hour) tall, peaked T-waves were noted on the ECG. Labs were drawn and potassium was 6.6 mEq/L and glucose was 393 mg/dL. Intravenous calcium chloride, 1000 mg, was titrated.  Repeat potassium was 6.1mEq/L and glucose 568 mg/dL.  The remainder of the procedure was uneventful and postoperative potassium was 5.2 mEq/dL.  

Author Biographies

Lisa Erlinger, PhD, CRNA, Midwestern University Wickenburg Community Hospital University of Missouri-Columbia

Assistant Professor MidWestern University-St. Louis University, Director of Surgical and Anesthesia Services Wickenburg Community Hospital

Terri Monk, MD, MS, University of Missouri-Columbia

Professor of Clinical Anesthesiology University of Missouri

Steven McAfee, MD, University of Missouri-Columbia

Anesthesiologist University of Missouri-Columbia

References

1. McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg. 1968;167(5):752-756. https://doi.org/10.1097/00000658-196805000-00013.
2. Puig I, Calvet X, Baylina M, et al. How and when should NSAIDS be used for preventing post ERCP pancreatitis? A systematic review and meta analysis. PLoS One. 2014;9(3):e92922. https://doi.org/10.1371/journal.pone.0092922.
3. Moffatt DC, Yu BN, Yie W, Bernstein CN. Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population based study. Gastrointest Endosc. 2014;79(4):615-622. https://doi.org/10.1016/j.gie.2013.08.028.
4. Malas A, Roberts K. Endoscopic retrograde cholangiopancreatography: Overview, Periprocedural care, Technique. Medscape. https://emedicine.medscape.com/article/1829797-overview. Published May 13, 2015. Accessed September 12, 2015.
5. Endoscopic retrograde cholangiopancreatography (ERCP), Institute for Cancer Genetics and informatics. YouTube. https://youtu.be/IRdA2krJ6LQ. Published September 13, 2013. Accessed November 19, 2016.
6. Muller TD, Finan B, Clemmensen C, Dimarchi RD, Tschop MH. The new biology and pharmacology of glucagon. Physiol Rev. 2017;97(2):721-766. https://doi.org/10.1152/physrev.00025.2016.
7. Physicians’ desk reference. Montvale, NJ: Thomson PDR; 2014.
8. Staritz M. Pharmacology of the sphincter of Oddi. Endoscopy. 1988;20(S 1):171-174. https://doi.org/10.1055/s-2007-1018170.
9. Rey JF, Greff M, Picazo J. Glucagon (1-21) peptide. Study of its action on sphincter of Oddi function by endoscopic manometry. Dig Dis Sci. 1986;31(4):355-360. https://doi.org/10.1007/BF01311669.
10. Ponce J, Garrigues V, Pertejo V, et al. Effects of intravenous glucagon-(1-21)-peptide on motor activity of sphincter of Oddi in humans. Dig Dis Sci. 1989;34(1):61-64. https://doi.org/10.1007/BF01536155.
11. Lahoti S, Catalano MF, Geenen JE, Hogan WJ. A prospective double blind trial of L-hyoscyamine versus glucagon for the inhibition of small intestinal motility during ERCP. Gastrointest Endosc. 1997;46(2):139-142. https://doi.org/10.1016/S0016-5107(97)70061-0.
12. Santeusanio F. Evidence for a role of endogenous insulin and glucagon in the regulation of potassium homeostasis. J Lab Clin Med. 1973;6:81.
13. Massara F, Martelli S, Cagliero E, Camanni F, Molinatti GM. Influence of glucagon on plasm levels of potassium in man. Diabetologia. 1980;19(5):414-417. https://doi.org/10.1007/BF00281818.
14. Christensen M. Factors that affect the variability in heart rate during endoscopic retrograde cholangiopancreatography. Eur J Surg. 2002;168:546-551.
15. Somers MP, Brady W, Perron A, Mattu A. The prominent T wave: electrocardiographic differential diagnosis. Am J Emerg Med. 2002;20(3):243-251. https://doi.org/10.1053/ajem.2002.32630.
16. Lynch CR, Khandekar S, Lynch SM, Disario JA. Sublingual L-hyoscyamine for duodenal antimotility during ERCP: a prospective randomized double-blinded study. Gastrointest Endosc. 2007;66(4):748-752. https://doi.org/10.1016/j.gie.2007.02.052.
Published
2018-11-07
How to Cite
ERLINGER, PHD, CRNA, Lisa; MONK, MD, MS, Terri; MCAFEE, MD, Steven. The Safety of Glucagon use during ERCP in Diabetic Patients with Renal Insufficiency: A Case Discussion and Review of Literature. Anesthesia eJournal, [S.l.], v. 6, p. 33-36, nov. 2018. ISSN 2333-2611. Available at: <http://anesthesiaejournal.com/index.php/aej/article/view/66>. Date accessed: 19 nov. 2018.
Section
Articles

Keywords

: ERCP, Glucagon, Diabetic, Renal insufficiency, Hyperkalemia