Accidental and intentional poisoning is a common reason for emergency department visits. Diagnosis is primarily clinical. Treatment is supportive for most poisonings, with IV fluids, vasopressors, and maintenance of airway.
Beta-blocker overdose should be considered in the diagnosis of patients presenting with bradycardia and hypotension. Other symptoms include seizures, hypoglycemia, and altered mental status. Treatment is supportive therapy and reversal of beta-blockade. Glucagon is the first-line antidote for beta-blocker toxicity. Calcium chloride, high-dose insulin, and IV lipid emulsion therapies may also be useful. Temporary pacing may be needed for bradycardia refractory to the above therapies.
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References:
Barton CA, Johnson NB, Mah ND, et al: Successful treatment of a massive metoprolol overdose using lipid emulsion and hyperinsulinemia/euglycemia therapy. Pharmacotherapy 35 (5):e56-60, 2015.
Engebretsen KM, Kaczmarek KM, Morgan J, Holfer JS: High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol 49 (4):277-283, 2011.
Graudins A, Lee HM, Druda D: Calcium channel antagonist and beta-blocker overdose: Antidotes and adjunct therapies. Br J Clin Pharmacol 81(3):453-461, 2016.
Shepard G: Treatment of poisoning caused by beta-adrenergic and calcium channel blockers. Am J Health Syst Pharm 63 (19):1828-1835, 2006.
Truitt CA, Brooks DE, Dommer P, LoVecchio F: Outcomes of unintentional beta-blocker or calcium channel blocker overdoses: A retrospective review of poison center data. J Med Toxicol 8 (2):135-139, 2012.