Glucagon constant-rate infusion: A novel strategy for the management of hyperinsulinemic-hypoglycemic crisis in the dog

A six-year-old, spayed female, cocker spaniel was presented for hypoglycemi c seizures. Hypoglycemia with concomitant hyperinsulinemia suggested an ins ulin-secreting tumor. Pancreatic masses were resected, and insulinoma was d iagnosed. Six weeks later, the dog presented in hyperinsulinemic-hypoglycem ic crisis (HHC). The dog was initially stabilized with intravenous dextrose boluses and infusions, but seizure activity recurred and persisted. A gluc agon constant-rate infusion (GCRI) was initiated,;and neurological signs qu ickly resolved. Dextrose was withdrawn over 24 hours, and euglycemia was ma intained by GCRI alone. Despite aggressive medical management including the use of prednisone, diazoxide, bovine somatotropin, and streptozocin, the d og presented on two subsequent occasions in HHC and both times was rapidly stabilized with GCRI alone. In this dog, GCRI was a fast, safe, and effecti ve method of achieving and maintaining euglycemia despite intractable hyper insulinism. The clinical use of GCRI merits further investigation for manag ement of HHC in veterinary.