What is the dose of glucagon for beta blocker (β-blocker) toxicity?

From the Guidelines

Glucagon should be administered at a dose of 2-10 mg IV bolus, followed by an infusion of 1-15 mg/hour, for the treatment of beta-blocker toxicity, as recommended by the most recent guidelines 1. The dose of glucagon for beta-blocker toxicity can be adjusted based on the patient's response, with a recommended initial dose of 2-10 mg IV bolus, followed by an infusion of 1-15 mg/hour 1.

• The infusion should be titrated to achieve an adequate hemodynamic response, including mean arterial pressure and evidence of good perfusion 1.
• Glucagon works by activating adenylyl cyclase through a non-beta receptor pathway, increasing intracellular cAMP and restoring cardiac contractility and heart rate, making it effective even in severe poisoning 1.
• Side effects of glucagon include nausea, vomiting, and hyperglycemia, and the medication should be reconstituted with the diluent provided by the manufacturer, not with normal saline, as this may cause precipitation 1.
• If glucagon is ineffective alone, additional therapies such as high-dose insulin-glucose therapy, calcium, vasopressors, or lipid emulsion therapy may be necessary, as recommended by the guidelines 1. Some key points to consider when administering glucagon for beta-blocker toxicity include:
• The patient's airway must be protected before glucagon administration, especially in patients with central nervous system depression 1.
• The infusion rate should be titrated to achieve an adequate hemodynamic response, and the patient should be closely monitored for signs of toxicity or adverse effects 1.

From the Research

Beta Blocker Toxicity and Glucagon Treatment

• Beta blocker toxicity can lead to significant morbidity and mortality, and treatment options are crucial in managing the condition 2.
• Glucagon is often used as a treatment for beta blocker toxicity, but its effectiveness and optimal dosage are still being studied.

Glucagon Dosage and Effectiveness

• The optimal dose of glucagon for treating beta blocker toxicity is not well established, but studies suggest that high-dose glucagon may be effective in increasing heart rate and cardiac output 3.
• A randomized clinical trial found that high-dose glucagon (50 µg/kg) increased mean heart rate by 13.0 beats per minute and systolic blood pressure by 15.6 mmHg compared to saline 3.
• Another study found that glucagon administration was associated with a statistically significant increase in heart rate, but the absolute difference was small and of uncertain clinical significance 4.

Adverse Effects of Glucagon

• Glucagon can cause adverse effects such as nausea, vomiting, and hyperglycemia, but these effects are generally mild and transient 3, 4.
• A case series found that 6.3% of glucagon administrations were associated with nausea and 9.7% with vomiting, while 10.4% were associated with hyperglycemia 4.

Clinical Guidelines and Recommendations

• Clinical guidelines recommend the use of glucagon in the treatment of beta blocker toxicity, but the evidence is largely based on animal studies and case reports 2, 5.
• A systematic review found that the evidence supporting the use of glucagon in beta blocker toxicity is limited, and more studies are needed to establish its effectiveness and optimal dosage 5.