Beta Blocker Poisoning/Overdose

Table of Contents

Aliases

Anti-hypertensive

Patient Care Goals

  1. Reduce GI absorption of oral agents with some form of binding agent (activated charcoal) especially for extended release
  2. Early airway protection is required as patients may have rapid mental status deterioration
  3. Assure adequate ventilation, oxygenation and correction of hypoperfusion

Patient Presentation

Beta blocker or beta adrenergic antagonist medication to reduce the effects of epinephrine/adrenaline

Inclusion Criteria

  1. Patients may present with:
    1. Bradycardia
    2. Hypotension
    3. Altered mental status
    4. Weakness
    5. Shortness of breath
    6. Possible seizures
  2. Beta blocker agents examples:
    1. Acebutolol hydrochloride (Sectral®)
    2. Atenolol (Tenormin®)
    3. Betaxolol hydrochloride (Kerlone®)
    4. Bisoprolol fumarate (Zebeta®)
    5. Carteolol hydrochloride (Cartrol®)
    6. Esmolol hydrochloride (Brevibloc®)
    7. Metoprolol (Lopressor®, Toprol XL®)
    8. Nadolol (Corgard®)
    9. Nebivolol (Bystolic®)
    10. Penbutolol sulfate (Levatol®)
    11. Pindolol (Visken®)
    12. Propranolol (Inderal®, InnoPran®)
    13. Timolol maleate (Blocadren) ®
    14. Sotalol hydrochloride(Betapace®)
  3. Alpha/beta-adrenergic blocking agents examples:
    1. Carvedilol (Coreg®)
    2. Labetalol hydrochloride (Trandate®, Normodyne®)

Exclusion Criteria

No recommendations

Patient Management

Assessment

  1. Assess ABCDs and if indicated expose and then cover to assure retention of body heat
  2. Vital signs which include temperature
  3. Apply a cardiac monitor, examine rhythm strip for arrhythmias, and consider obtaining a 12-lead EKG
  4. Check blood glucose level
  5. Monitor pulse oximetry and ETCO2 for respiratory decompensation
  6. Identify specific medication taken (noting immediate release vs. sustained release formulations), time of ingestion, and quantity
  7. Pertinent cardiovascular history or other prescribed medications for underlying disease
  8. Patient pertinent history
  9. Patient physical

Treatment and Interventions

  1. Check blood glucose level on all patients but especially on pediatric patients as beta blockers can cause hypoglycemia in pediatric population
  2. Consider atropine sulfate for symptomatic bradycardia
    1. Adult: Atropine 0.5 mg IV every 5 minutes to maximum of 3 mg
    2. Pediatric: Atropine 0.02 mg/kg (0.1 – 0.5 mg per dose) every 5 minutes, maximum total dose 1 mg
  3. Consider fluid challenge (20 mL/kg) for hypotension with associated bradycardia
  4. For symptomatic patients with cardiac effects (i.e. hypotension, bradycardia) consider:
    1. Glucagon:
      1. Glucagon 1 mg IVP (Over 25 kg)
      2. Glucagon 0.5 mg IVP (less than 25 kg)
  5. Consider vasopressors after adequate fluid resuscitation for the hypotensive patient [see Shock guideline for pediatric vs. adult dosing]
  6. Consider transcutaneous pacing if refractory to initial pharmacologic interventions
  7. If seizure, treat per Seizures guideline
  8. If widened QRS (100 msec or greater), consider sodium bicarbonate 1 meq/kg IV. This can be repeated as needed to narrow QRS

Notes – Beta Blocker Poisoning/Overdose