| Mr. Ibrahem/Beta blocker toxicity | |
|---|---|
| Other names | Beta blocker poisoning, beta blocker overdose |
 | |
| A 20% lipid emulsion may be used for beta blocker toxicity | |
| Specialty | Emergency medicine |
| Symptoms | Slow heart rate, low blood pressure [1] |
| Complications | Irregular heartbeat, low blood sugar [1] |
| Usual onset | Within 2 hours [2] |
| Causes | Too much beta blockers either by accident or on purpose [2] |
| Differential diagnosis | Calcium channel blocker toxicity, acute coronary syndrome, hyperkalemia [1] |
| Treatment | Activated charcoal, whole bowel irrigation, intravenous fluids, sodium bicarbonate, glucagon, high dose insulin, vasopressors, lipid emulsion, ECMO [1] |
| Prognosis | High risk of death [3] |
| Frequency | Relatively uncommon [1] |
Beta blocker toxicity is the taking of too much of the medications known as beta blockers, either by accident or on purpose. [2] This often causes a slow heart rate and low blood pressure. [1] Some beta blockers can also cause an irregular heartbeat or low blood sugar. [1] Symptoms usually occur in the first two hours but with some forms of the medication may not start until 20 hours. [2] A person may be medically cleared if they have no symptom 6 hours after taking an immediate release preparation. [4]
Beta blockers include metoprolol, bisoprolol, carvedilol, propranolol, and sotalol. [1] ECG changes may include PR prolongation and a wide QRS. [1] Measuring blood levels of beta blockers is not useful. [1] Other conditions that may present similarly include calcium channel blocker toxicity, acute coronary syndrome, and hyperkalemia. [1]
Treatment may include efforts to reduce absorption of the medication including: activated charcoal taken by mouth if given shortly after the ingestion or whole bowel irrigation if an extended release formula was taken. [1] Efforts to bring about vomiting are not recommended. [1] Medications to treat the toxic effects include: intravenous fluids, sodium bicarbonate, glucagon, high dose insulin, vasopressors and lipid emulsion. [1] Extracorporeal membrane oxygenation and electrical pacing may also be options. [1] Some beta blockers may be removable by dialysis. [1]
Beta blocker toxicity is relatively uncommon. [1] Along with calcium channel blockers and digoxin beta blockers have one of the highest rates of death in overdose. [3] These medications first became available in the 1960s and 1970s. [2] [4]
References
- ^ a b c d e f g h i j k l m n o p q Palatnick, Wesley (September 2020). "Calcium-Channel Blocker, Beta Blocker, and Digoxin Toxicity Management Strategies". www.ebmedicine.net. Archived from the original on 14 May 2014. Retrieved 27 December 2020.
- ^
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b
c
d
e Khalid, MM; Galuska, MA; Hamilton, RJ (January 2020). "Beta-Blocker Toxicity".
PMID
28846217.
{{ cite journal}}: Cite journal requires|journal=( help) - ^ a b Marx, John A. Marx (2014). "Cardiovascular Drugs". Rosen's emergency medicine: concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 152. ISBN 1455706051.
- ^ a b Wall, Ron (2017). Rosen's Emergency Medicine: Concepts and Clinical Practice (9 ed.). Elsevier. p. 1881. ISBN 978-0323354790.