Beta Blocker Overdose

Aka: Beta Blocker Overdose, Beta Blocker Toxicity

1. See Also
   1. Beta Blocker
   2. Drug Overdose
2. Symptoms and Signs
   1. Acidosis
   2. Bradycardia
   3. Bronchospasm
   4. Coma
   5. Hyperglycemia or Hypoglycemia
   6. Hyperkalemia
   7. Hypotension
   8. Respiratory depression
   9. Seizures
3. Management: Adults (same as for Calcium Channel Blocker Overdose)
   1. Glucagon
      1. Initial: 50-150 mcg/kg IV bolus
      2. Next: May repeat in 3-5 minutes
      3. Next: Infusion at effective dose
   2. Calcium Gluconate (10% solution)
      1. Bolus: 0.6 ml/kg over 5-10 minutes
      2. Next: Infuse at 0.6 to 1.5 ml/kg/hour
   3. Epinephrine
      1. Start: 1 mcg/kg/min
      2. May need to titrate to higher dose
   4. Insulin Euglycemia protocol
      1. Keep Serum Glucose 100-250 mg/dl
      2. Start
         1. Regular Insulin 1 IU/kg IV and
         2. Dextrose 25 g IV
      3. Next
         1. Regular Insulin 0.5 IU/kg/hour IV and
         2. Dextrose 0.5 g/kg/hour
   5. Sodium Bicarbonate (1 mEq/ml solution)
      1. Dose: 50 mEq bolus
4. Management: Children (same as for Calcium Channel Blocker Overdose)
   1. Glucagon
      1. Initial: 50-150 mcg/kg IV bolus
      2. Next: May repeat in 3-5 minutes
      3. Next: 0.1 mg/kg/hour infusion
   2. Calcium Gluconate (10% solution)
      1. Bolus: 0.6 ml/kg over 5-10 minutes
      2. Next: Infuse at 0.6 to 1.5 ml/kg/hour
   3. Epinephrine
      1. Start: 1 mcg/kg/min (up to 10-30 mcg/min)
      2. May need to titrate to higher dose
   4. Insulin Euglycemia protocol
      1. Keep Serum Glucose 100-250 mg/dl
      2. Start
         1. Regular Insulin 1 IU/kg IV and
         2. Dextrose 25 g IV
      3. Next
         1. Regular Insulin 0.5 IU/kg/hour IV and
         2. Dextrose 0.5 g/kg/hour
   5. Sodium Bicarbonate (1 mEq/ml solution)
      1. Indicated only if QRS interval widening >120 ms
      2. Dose: 1-2 mEq/kg up to 50 mEq bolus
5. References
   1. Anderson (2008) Clin Pediatr Emerg Med 9(1): 4-16
   2. Kerns (2007) Emerg Med Clin North Am 25(2):309-31