From the Guidelines
For beta blocker overdose, glucagon should be administered as an initial bolus of 2-10 mg (0.05-0.15 mg/kg) intravenously, followed by a continuous infusion of 1-15 mg/hour titrated to clinical response, as recommended by the most recent guidelines 1. The dosage of glucagon for beta blocker overdose is crucial in managing the associated hypotension and bradycardia.
- The initial bolus dose is 2-10 mg for adults and 0.05-0.15 mg/kg for pediatric patients.
- The maintenance infusion dose is 1-15 mg/hour for adults.
- It is essential to prepare glucagon in D5W or normal saline, avoiding mixing with solutions containing calcium, and to monitor for side effects such as nausea, vomiting, and hyperglycemia.
- Glucagon works by activating adenylyl cyclase through a separate receptor pathway from beta receptors, increasing intracellular cAMP and restoring cardiac contractility and heart rate independent of blocked beta receptors.
- Additional cardiovascular support measures should be available, as glucagon may not be sufficient in severe overdoses. The most recent guidelines from 2023 provide the most up-to-date recommendations for glucagon dosage in beta blocker overdose, superseding previous guidelines from 2019 1 and 2020 1.
From the Research
Dosage of Glucagon for Beta Blocker Overdose
- The dosage of glucagon to administer for beta blocker overdose is 50 micrograms/kg iv loading dose, followed by a continuous infusion of 1-15 mg/h, titrated to patient response 2.
- In one case, a patient was treated with glucagon 5 mg followed by a glucagon drip, but the exact dosage of the drip is not specified 3.
- The use of glucagon in beta blocker overdose is based on limited evidence from animal studies, which suggest that it can increase heart rate and cardiac output, at least transiently 4.
- Glucagon's mechanism of action may bypass the beta-adrenergic receptor site, making it a potential alternative therapy for profound beta-blocker intoxications 2.
Administration and Monitoring
- Glucagon should be administered intravenously, with monitoring for side effects such as nausea, vomiting, hypokalemia, and hyperglycemia 2.
- The effectiveness of glucagon in treating beta blocker overdose may be limited, and other treatments such as high-dose insulin and intravenous lipid emulsion may be considered in severe cases 5, 3.