From the Guidelines
Beta blocker overdose is typically associated with cardiogenic shock, characterized by decreased cardiac output, hypotension, and inadequate tissue perfusion due to the inhibition of beta-adrenergic receptors in the heart. This type of shock occurs because beta blockers decrease heart rate and cardiac contractility, leading to reduced cardiac output and hypotension. In overdose situations, these effects become profound, resulting in shock. According to the 2023 American Heart Association guidelines 1, treatment for beta blocker overdose includes supportive care and pharmacological interventions such as vasopressors, high-dose insulin, and glucagon.
- Key features of cardiogenic shock due to beta blocker overdose include:
- Decreased cardiac output
- Hypotension
- Bradycardia
- Reduced cardiac contractility
- Treatment options for beta blocker overdose, as recommended by the guidelines 1, include:
- Vasopressors for hypotension
- High-dose insulin therapy for hypotension refractory to vasopressors
- Glucagon for bradycardia or hypotension
- Extracorporeal life support techniques, such as VA-ECMO, for life-threatening beta blocker poisoning with cardiogenic shock refractory to pharmacological interventions. The guidelines also suggest that atropine may be reasonable for beta blocker-induced bradycardia, and hemodialysis may be considered for life-threatening atenolol or sotalol poisoning 1. However, intravenous lipid emulsion therapy is not likely to be beneficial for life-threatening beta blocker poisoning, as stated in the guidelines 1.
From the Research
Type of Shock Associated with Beta Blocker Overdose
- Beta blocker overdose is associated with cardiogenic shock, as evidenced by studies 2, 3, 4, 5, 6
- Cardiogenic shock is a life-threatening condition that can lead to severe morbidity and mortality if not properly treated
- The use of high-dose insulin, vasopressors, and other advanced treatments such as ECMO may be indicated depending on the severity of the overdose and the specific agents involved 3, 4, 5, 6
Characteristics of Cardiogenic Shock in Beta Blocker Overdose
- Cardiogenic shock in beta blocker overdose is characterized by bradycardia and hypotension 5
- The condition can be refractory to traditional therapies, requiring the use of high-dose insulin and other advanced treatments 3, 4, 6
- Early recognition and treatment of beta blocker overdose are crucial to prevent severe morbidity and mortality 2, 5