Beta blocker poisoning
- Fermin Barrueto, Jr, MD, FACEP, FAAEM, FACMT
Fermin Barrueto, Jr, MD, FACEP, FAAEM, FACMT
- Clinical Associate Professor
- University of Maryland School of Medicine
- Section Editor
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Beta adrenergic antagonists (beta blockers) have been in clinical use for more than 30 years, and are employed in the management of a range of disorders, including hypertension, ischemic heart disease, heart failure, arrhythmias, migraine headache, tremor, portal hypertension, and aortic dissection. Although safe for most patients when taken as prescribed, beta blocker toxicity is associated with significant morbidity and mortality. In 2006, there were 9041 single beta blocker exposures reported to poison centers in the United States. Of these, there were 613 moderate or major adverse outcomes and four deaths .
Complications following beta blocker overdose are related to excessive beta adrenergic blockade, and occasionally the proarrhythmic (membrane-stabilizing) activity of these agents on cardiac conduction . Ingestion of other cardioactive agents in association with beta blockers increases mortality following overdose [2,3]. Common and potentially dangerous coingestions include calcium channel blockers, cyclic antidepressants, and neuroleptics .
An overview of beta blocker intoxication will be presented here. A summary table to facilitate emergent management is provided (table 1). A general approach to an adult patient with possible drug intoxication, and an overview of adverse effects of beta blockade, are discussed separately. (See "General approach to drug poisoning in adults" and "Major side effects of beta blockers".)
Receptor types and general mechanism — There are at least three distinct types of beta receptors:
●Beta 1, which are found primarily in heart muscle. Activation of these receptors results in an increase in heart rate, contractility, atrioventricular (AV) conduction, and a decrease in AV node refractoriness.
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- Receptor types and general mechanism
- CELLULAR TOXICOLOGY
- TOXICITY OF SPECIFIC AGENTS
- CLINICAL FEATURES OF OVERDOSE
- Physical findings
- LABORATORY EVALUATION
- Laboratory studies
- DIFFERENTIAL DIAGNOSIS
- Acute stabilization and overview of therapy
- Approach to the selection of specific therapies
- - Severely symptomatic patients
- - Mildly symptomatic patients
- - Asymptomatic patients
- Specific therapies
- - Glucagon
- - Calcium
- - Vasopressor (catecholamine)
- - Insulin and glucose
- - Lipid emulsion therapy
- - Gastrointestinal (GI) decontamination
- - Other therapies
- Pediatric considerations
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS