From the Research
For beta blocker overdose, epinephrine is typically administered at 1-10 mcg/min IV infusion initially, which can be titrated up to 50-100 mcg/min based on clinical response, as supported by the most recent and highest quality study 1.
Key Considerations
- The dose of epinephrine may need to be adjusted based on the patient's response and the severity of the overdose.
- Epinephrine should be used after initial treatments like atropine, glucagon, and calcium have been attempted, as recommended by 2 and 1.
- Fluid resuscitation should be optimized before or concurrent with epinephrine administration to ensure adequate blood pressure and perfusion.
- Continuous cardiac monitoring and frequent blood pressure checks are crucial when administering epinephrine to monitor for potential complications such as arrhythmias, myocardial ischemia, and hypertensive crisis.
Mechanism of Action
- Epinephrine works by stimulating both alpha and beta receptors, helping to overcome the competitive blockade caused by the beta blocker, as explained in 2.
- This increases heart rate, contractility, and peripheral vascular resistance to counteract hypotension and bradycardia.
Potential Complications
- Higher doses of epinephrine may be required in severe cases, but this increases the risk of complications such as arrhythmias, myocardial ischemia, and hypertensive crisis, as noted in 1.
- The use of epinephrine should be carefully considered and monitored in patients with underlying cardiovascular disease or other comorbidities.
Additional Treatments
- Other treatments such as high-dose insulin euglycaemia treatment and advanced therapies like ECMO may be indicated depending on the severity of toxicity and specific agents involved, as recommended by 1.
- The treatment of beta blocker overdose should be individualized based on the patient's clinical presentation and response to initial treatments.