beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management.
Hemodynamically unstable: accidental atenolol toxicity?. 2019 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 37th Annual Report. Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Brooks DE, Dibert KW, et al. Chiral interactions of the drug propranolol and a1-acid-glycoprotein at a micro liquid-liquid interface. New York, NY: McGraw-Hill Education 2015. In: Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR, eds. Norepinephrine is not unreasonable but careful due to the predominantly vasoconstricting effects without inotropy, which due to increased afterload, can negatively affect cardiac output.Brubacher JR. Avoid Isoproterenol as this can cause peripheral vasodilation and thus hypotension avoid dobutamine alone for this same reason. Catecholamines – first line are Epinephrine or Dopamine, due to both inotropic effect and vasoconstriction. Acts to increase contractility, does not raise HR. CaCl has 3-5x more calcium than Ca gluconate, but is sclerosing to veins and hence must be given through central lines. IV calcium – can give CaCl (if have central line) or Ca Gluconate (if peripheral line). Even though this is considered a 1st-line “antidote” there is actually limited data to support this. This increases contractility and possibly heart rate. If positive response, can start an infusion at 2-5 mg/hour.Īctivates adenylate cyclase to raise cAMP levels, which increases intracellular Ca releat. Glucagon – 5 mg bolus over 1 minute, can repeat 10-15 minutes later. Side effects: Anticholinergic effects = 1) CNS effects, 2) GI – decreased saliva, nausea, vomiting, ileus, 3) GU – urinary retention, 4) CV – tachycardia (obviously) and arrhythmias, 5) Eyes – blurry visionĢ. Also does not work in transplanted hearts (as they lack vagal innervation).
Atropine – 0.5 mg pushes at a time, q3-5 minutes, maximum of 3 g.Īcts at the AV node – will not work for block at or below the bundle of His. Medical Therapy for Beta-Blocker Toxicity:ġ.
On EKG, can see PR prolongation leading ot AV block, and sometimes QRS prolongation (with certain beta blockers like sotalol). Clinical Manifestations: Mainly hypotension and bradycardia.
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