From the Guidelines
Treatment for beta blocker overdose or toxicity involves administering medications to counteract the effects of beta blockers on the heart and blood vessels.
Treatment Options
- Glucagon: a bolus of 3 to 10 mg, administered slowly over 3 to 5 minutes, followed by an infusion of 3 to 5 mg/h, is recommended to increase heart rate and improve symptoms in patients with beta-blocker overdose 1.
- High-dose insulin: a bolus of 1 unit/kg followed by an infusion of 0.5 units/kg/h, has been shown to improve heart rate, hemodynamic parameters, and mortality in beta-blocker overdose 1.
- Calcium: administration of intravenous calcium, such as calcium chloride or calcium gluconate, may be considered to increase heart rate and improve symptoms in patients with beta-blocker overdose, although the evidence is less consistent 1.
- Vasopressors: may be used to support blood pressure, but their effectiveness may be limited in beta-blocker overdose 1.
- Atropine: may be used to treat bradycardia, but its effectiveness in beta-blocker overdose is not well established 1.
Important Considerations
- Hypoglycemia: may occur in patients with beta-blocker overdose, and supplemental dextrose should be administered as part of standard care 1.
- ECMO: may be considered in refractory cases of beta-blocker overdose, although the evidence is limited 1.
From the Research
Treatment for Beta Blocker Overdose or Toxicity
The treatment for beta blocker overdose or toxicity involves several approaches, including:
- Gastric decontamination with activated charcoal or gastric lavage, although the effectiveness of these methods is unclear 2
- Administration of catecholamines, inotropes, and vasopressors to improve haemodynamics 2
- Use of atropine to improve heart rate and blood pressure 2
- Administration of intravenous calcium to improve haemodynamics, although the effectiveness of this approach is unclear 2
- High-dose insulin euglycaemic therapy, which has been associated with improved haemodynamics and reduced mortality 2
- Use of glucagon, which has been associated with minor improvements in haemodynamics 2
- Consideration of veno-arterial extracorporeal membrane oxygenation in cases of severe cardiogenic shock or cardiac arrest 2
- Use of temporary overdrive cardiac pacing to prevent arrhythmias in sotalol toxicity 2
First-Line Treatment
High-dose glucagon is considered the first-line antidote for beta-blocker poisoning where symptomatic bradycardia and hypotension are present 3
Treatment Approach
A graduated response to cardiovascular instability is recommended, starting with intravenous fluids and commencement of a single or combination of catecholamine inotropes and vasopressors, depending on the type of haemodynamic compromise 2