From the Guidelines
Beta blocker overdose is a life-threatening condition that requires immediate medical attention, and treatment typically involves supportive care and specific antidotes, with glucagon being the first-line antidote. The effects of beta blocker overdose can be severe, including bradycardia, hypotension, dysrhythmias, and cardiogenic shock 1. Initial management includes securing the airway, breathing, and circulation, and for hypotension, intravenous fluids like normal saline should be administered.
Treatment Options
- Glucagon is given as 5-10 mg IV bolus followed by an infusion of 1-5 mg/hour, and is effective in increasing cardiac output by activating adenylyl cyclase through a separate receptor pathway, bypassing the blocked beta receptors 1.
- High-dose insulin therapy (1 unit/kg bolus followed by 0.5-1 unit/kg/hour) with glucose supplementation is effective for severe cardiovascular toxicity, and has been shown to improve heart rate, hemodynamic parameters, and mortality in beta-blocker overdose 1.
- Atropine can be used for bradycardia (0.5-1 mg IV every 3-5 minutes, maximum 3 mg), while vasopressors like norepinephrine may be needed for persistent hypotension.
- Hemodialysis is rarely helpful except for specific water-soluble beta blockers.
- Activated charcoal (1 g/kg) can be administered within 1-2 hours of ingestion if the airway is protected.
Key Considerations
- Beta blocker toxicity occurs because these medications block beta-adrenergic receptors, leading to decreased heart rate, contractility, and blood pressure 1.
- The EXTRIP workgroup recommends that extracorporeal life support (ECLS) may be considered in severe cases of beta-blocker poisoning, although the evidence is limited and the decision to use ECLS should be made on a case-by-case basis 1.
- The American Heart Association guidelines recommend the use of high-dose insulin with glucose and IV glucagon in patients with beta-blocker overdose who are in refractory shock 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Effects of Beta Blocker Overdose
The effects of beta blocker overdose can be severe and life-threatening. According to 2, in 2003, US poison centers reported 15,350 cases of beta-blocker ingestion, resulting in 33 deaths. The clinical presentation of overdose can include:
- Cardiovascular manifestations such as bradycardia, hypotension, and cardiogenic shock 3, 4, 5, 6
- Neurologic manifestations such as dizziness, confusion, and seizures 5
- Pulmonary complications such as respiratory failure 5
- Other complications such as hypoglycemia and hypokalemia 3
Treatment of Beta Blocker Overdose
The treatment of beta blocker overdose depends on the severity of the symptoms and the specific agent involved. According to 3, the following treatments may be effective:
- Catecholamines, vasopressors, and high-dose insulin euglycaemic therapy may improve hemodynamics and reduce mortality 3
- Glucagon may improve heart rate and blood pressure 3, 4
- Calcium salts may improve hemodynamics 6
- Veno-arterial extracorporeal membrane oxygenation (ECMO) may be indicated in severe cases 3, 6
- Gastric decontamination with activated charcoal may be considered in some cases 2, 3
Management of Beta Blocker Overdose
The management of beta blocker overdose involves supportive care, cardiac monitoring, and specific treatment. According to 2, the following steps may be taken:
- Patients with suspected self-harm or malicious administration of beta-blocker should be referred to an emergency department immediately 2
- Patients without evidence of self-harm should have further evaluation, including determination of the precise dose ingested and the presence of co-ingestants 2
- Asymptomatic patients who ingest more than the referral dose should be sent to an emergency department for monitoring and treatment 2
- Ambulance transportation is recommended for patients who are referred to emergency departments due to the potential for life-threatening complications 2