Treat beta blocker overdose
Pro Research Analysisby 
Searched over 200M research papers
Effective Treatments for Beta-Blocker Overdose
Introduction to Beta-Blocker Overdose
Beta-blocker overdose is a serious medical condition that can lead to significant morbidity and mortality. The primary clinical manifestations include bradycardia (slow heart rate) and hypotension (low blood pressure)1 2. Prompt recognition and appropriate treatment are crucial for improving patient outcomes.
Initial Management and Supportive Care
Gastric Decontamination
Initial management often includes gastric decontamination methods such as activated charcoal and gastric lavage. However, the effectiveness of these interventions is difficult to isolate due to the concurrent use of multiple treatments1.
Intravenous Fluids
Intravenous fluids are typically the first line of treatment to stabilize cardiovascular function. This is often followed by more specific pharmacological interventions depending on the severity of the overdose1.
Pharmacological Interventions
Catecholamines, Inotropes, and Vasopressors
Catecholamines, inotropes, and vasopressors are commonly used to improve haemodynamics. These agents have shown benefits in survival and haemodynamic parameters in several case reports and series1 2. They are particularly useful in managing bradycardia and hypotension.
High-Dose Insulin Euglycemic Therapy (HIET)
High-dose insulin euglycemic therapy has emerged as a significant treatment option. It has been associated with improved survival and haemodynamic parameters in multiple case series1 9. The typical regimen includes an initial bolus followed by a continuous infusion, with careful monitoring for hypoglycemia and hypokalemia1 9.
Glucagon
Glucagon is considered a first-line antidote for beta-blocker overdose, especially in cases presenting with symptomatic bradycardia and hypotension. It works by increasing heart rate and myocardial contractility, bypassing the beta-adrenergic receptor blockade3 4 5. The recommended dosing involves an initial intravenous bolus followed by a continuous infusion, titrated to patient response5.
Calcium
Intravenous calcium can be beneficial, particularly in cases where beta-blocker overdose is complicated by concurrent calcium channel blocker toxicity. It helps improve haemodynamics by increasing myocardial contractility1 2.
Advanced Treatments
Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO)
For severe cases unresponsive to pharmacological treatments, VA-ECMO can be considered. This advanced intervention has been associated with improved survival in patients experiencing severe cardiogenic shock or cardiac arrest due to beta-blocker overdose1.
Intravenous Lipid Emulsion Therapy
Intravenous lipid emulsion therapy has shown variable responses in treating beta-blocker toxicity. It is generally considered when other treatments fail, although its efficacy is not well-established1.
Conclusion
Effective management of beta-blocker overdose requires a multi-faceted approach. Initial supportive care with intravenous fluids is essential, followed by specific pharmacological treatments such as catecholamines, high-dose insulin euglycemic therapy, and glucagon. Advanced interventions like VA-ECMO may be necessary for refractory cases. While the evidence is primarily drawn from low-quality studies, these treatments collectively offer a structured approach to improving patient outcomes in beta-blocker overdose scenarios.
Sources and full results
Most relevant research papers on this topic
Treatment for beta-blocker poisoning: a systematic review
Catecholamines, inotropes, and vasopressors may provide a survival benefit and improve haemodynamics in beta-blocker poisoning, but their effectiveness is uncertain.
Systematic ReviewBeta blocker and calcium channel blocker toxicity: Current evidence on evaluation and management.
Beta blocker and calcium channel blocker overdoses can cause severe morbidity and mortality, and proper treatment involves calcium salts, vasopressors, and high-dose insulin euglycemia treatment.
Treatment of poisoning caused by beta-adrenergic and calcium-channel blockers.
High-dose glucagon is the first-line antidote for beta-blocker poisoning, while a combination of calcium and epinephrine is recommended for calcium-channel blocker poisoning.
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Glucagon for the treatment of symptomatic beta blocker overdose.
Intravenous glucagon can support blood pressure in beta blocker overdose patients, as supported by six best evidence papers.
Systematic ReviewGlucagon therapy for beta-blocker overdose.
Glucagon therapy effectively reverses cardiovascular depression in severe beta-blocker overdoses, with potential for future clinical acceptance due to its high cost and limited availability.
Case ReportBeta-Blocker Overdose: “You know, the green pill.”
Beta-blocker overdoses can be fatal if not treated quickly and aggressively, but can be managed with supportive care and supportive medications.
Management of Beta-Adrenergic Blocker Poisoning
Beta-adrenergic blocking agents (-blockers) are a significant cause of overdose and second-most common cause of cardiovascular agent mortality, with proper management being crucial in overdose settings.
Treatment of poisoning caused by β-adrenergic and calcium-channel blockers
High-dose glucagon is the first-line antidote for -blocker poisoning, while a combination of calcium and epinephrine is recommended for CCB poisoning, with HDIDK reserved for refractory cases.
Highly CitedAn Overview of Hyperinsulinemic‐Euglycemic Therapy in Calcium Channel Blocker and β‐blocker Overdose
Hyperinsulinemic-euglycemic therapy (HIET) shows promise in treating calcium channel blocker and beta blocker overdoses, with a success rate of 80.4-1000% when closely monitored.
Systematic ReviewClinical toxicology of beta‐blocker overdose in adults
Beta-blocker overdoses in adults show no significant differences in poisoning severity, and no fatalities were observed with single-substance exposures, but co-exposures with other antihypertensives, sedatives, or alcohol should be carefully attended to.
Observational Study