Beta-Blocker Overdose
OVERVIEW
- most ingestions are benign
- exceptions are those in the elderly those with decreased cardio-respiratory reserve, and those with co-ingestions of other cardiovascularly active agents
- two beta-blockers require special consideration:
— propanolol -> causes sodium channel blockade -> QRS widening -> treat with NaHCO3
— sotalol -> causes potassium efflux blockade -> long QT -> monitor for Torsades
CLINICAL FEATURES
- proportional to the type and amount ingested
- CVS: hypotension, bradycardia, AV block, heart failure
- RESP: bronchospasm
- METABOLIC: hypoglycaemia, hyperkalaemia
- NEURO: stupor, coma, seizures
MANAGEMENT
Resuscitation
- fluid
- beta-agonists
- vasopressors
- atropine
- pacing
Acid-base and Electrolytes Balance
- hypoglycaemia -> dextrose
- hyperkalaemia: Ca2+ gluconate, dextrose-insulin, NaHCO3, dialysis, salbutamol
Decontamination
- activated charcoal if <1 hour and no CI
Antidotes
- glucagon 50mcg/kg up to 10mg -> 2-10mg/hr (traditional option but inferior to HIET)
- high dose insulin euglycaemic therapy
- consider intralipid if refractory to standard measures
References and Links
LITFL
- ECG Library – Beta Blocker overdose
Journals
- Bailey B. Glucagon in beta-blocker and calcium channel blocker overdoses: a systematic review. J Toxicol Clin Toxicol. 2003;41(5):595-602. PMID: 14514004.
- Boyd R, Ghosh A. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Glucagon for the treatment of symptomatic beta blocker overdose. Emerg Med J. 2003 May;20(3):266-7. PMC1726108.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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