Pathophysiology

Complications following beta blocker overdose are related to the excessive beta-adrenergic blockade, the proarrhythmic activity of these agents, and lipophilicity:

Presentation

• Bradycardia

• Bronchospasm

• Hypotension

• Hypoglycemia

• Hyperkalemia

• Widened QRS, ventricular arrhythmias, and prolonged QTc

• Seizures, coma

Diagnosis

Consult Poison Control: 1800-222-1222

Obtain blood gas, lactate, CMP, EKG, and screen for co-ingestions

1. What type of product was ingested (immediate vs. sustained release)?

2. Any presence of synergistic co-ingestants (calcium channel blockers, TCAs, antipsychotics)?

3. Any underlying cardiovascular disease that could be particularly vulnerable to beta-blocker toxicity?

Management

Additional treatments for refractory hypotension and bradycardia:

Monitoring:

Asymptomatic patients without the need for further interventions can be discharged after a six-hour period of observation. Patients who have ingested an extended-release preparation, sotalol, or multiple cardioactive agents should be observed for 24 hours even if they are asymptomatic.

References

1.     American Academy of Pediatrics. Poisoning. In: McInerny TK, Adam HM, Campbell DE, DeWitt TG, Foy JM, Kamat DM, eds. American Academy of Pediatrics Textbook of Pediatric Care. American Academy of Pediatrics; 2017;

2.     Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. [Updated 2020 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448097/

3.     Wax P, et al.  β-Blocker Ingestion: An Evidence-Based Consensus Guideline for Out-of-Hospital Management, Clinical Toxicology, 43:3, 131-146, DOI: 10.1081/CLT-62475