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Beta Blocker Overdose

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Beta Blocker Overdose, Beta Blocker Toxicity

  • Pathophysiology
  1. Selective Beta Blockers lose selectivity in Overdose
    1. Overdosed Beta Blockers affect all receptors regardless of whether agent is beta-1 or beta-2 selective
  2. Beta Blocker Overdose is treated the same as Calcium Channel Blocker Overdose
  • Precautions
  1. Beta Blocker Overdoses are high risk of death (on par with Tricyclic Antidepressants and Calcium Channel Blockers)
    1. Treat at similar intensity as a full code as these patients decompensate rapidly
  • Symptoms and Signs
  1. Primary toxic effects
    1. Bradycardia
    2. Hypotension
  2. Other effects
    1. Acidosis
    2. Bronchospasm
    3. Coma
    4. Hypoglycemia (esp. in children)
      1. Contrast with Hyperglycemia in Calcium Channel Blocker Overdose
    5. Hyperkalemia
    6. Respiratory depression
  3. Lipophilic Beta Blockers (primarily Propranolol, but also Metoprolol and Pindolol)
    1. Seizures
    2. QRS Widening
  • Management
  1. See Calcium Channel Blocker Overdose for management
  2. Specific concerns with Beta Blocker Overdose (contrast with calcium channel Overdose)
    1. Hypoglycemia
      1. Monitor Glucose every 30 min (more often if on euglycemic Insulin protocol)
      2. Start D10 if Glucose is trending downward