Beta-blocker toxicity: Difference between revisions
| Line 53: | Line 53: | ||
If IV fluid and atropine are not sufficient then consider | If IV fluid and atropine are not sufficient then consider: | ||
*Glucagon | *Glucagon | ||
**Half-life is 20min | |||
**Consider concurrent administration of ondansetron (causes n/v) | |||
**Adult: 5mg IV bolus over one minute | **Adult: 5mg IV bolus over one minute | ||
**Ped: 50mcg/kg | **Ped: 50mcg/kg | ||
**Rebolus if no response after 10min | **Rebolus if no response after 10min | ||
**If effective start infusion at | **If effective start infusion at: | ||
***Adult: 2-5mg/hr | ***Adult: 2-5mg/hr | ||
***Ped: 70mcg/kg/hr | ***Ped: 70mcg/kg/hr | ||
* | *High dose insulin and glucose | ||
** | **Augments myocardial contraction | ||
| Line 76: | Line 75: | ||
***Adult: Start 1 mcg/min and titrate to MAP=60 | ***Adult: Start 1 mcg/min and titrate to MAP=60 | ||
***Ped: Start 0.1mcg/kg/min | ***Ped: Start 0.1mcg/kg/min | ||
Revision as of 19:26, 23 March 2011
Background
- Coingestion with CCB, cyclics, and neuroleptics increases mortality
- Agents with membrane-stabilizing activity are esp lethal
- Prolongs QT > dysrhythmias
- Propranolol
- Sotalol
- Prolongs QT > dysrhythmias
Diagnosis
- Cardiac
- Bradycardia
- Hypotension
- Ventricular dysrhythmias
- CNS
- Mental status change
- Delirium, coma
- Seizure (esp w/ propranolol)
- Mental status change
- Other
- Hypoglycemia (uncommon in adults)
- Bronchospasm (uncommon)
Work-Up
- ECG
- PR prolongation
- Bradycardia
- QT prolongation
- Any bradydysrhythmia
- Glucose
- Chemistry
DDx
- Calcium-channel blockers
- Unlikely to cause CNS changes
- Hyperglycemia is more common
- Digoxin
- Nausea/vomiting is more common
- Clonidine
- Miosis, somnolence
- Cholinergic agents
- SLUDGE
Management
- Consider charcoal if present within 2 hr of ingestion
- Bradycardia (symptomatic)
- Atropine 0.5-1mg q3-5min up to 0.04mg/kg
- Hypotension
- IV fluids
- Hypoglycemia
- Adult - D50
- Ped - 2.5mL/kg of D10
If IV fluid and atropine are not sufficient then consider:
- Glucagon
- Half-life is 20min
- Consider concurrent administration of ondansetron (causes n/v)
- Adult: 5mg IV bolus over one minute
- Ped: 50mcg/kg
- Rebolus if no response after 10min
- If effective start infusion at:
- Adult: 2-5mg/hr
- Ped: 70mcg/kg/hr
- High dose insulin and glucose
- Augments myocardial contraction
- Vasopressors
- Consider if all of above has failed
- Epinephrine
- Adult: Start 1 mcg/min and titrate to MAP=60
- Ped: Start 0.1mcg/kg/min
- Hemodialysis
- Only effective for atenolol, sotalol
Disposition
- Admit all symptomatic patients
- Admit all sotalol ingestions (long half-life)
- Observe all others for ~ 6hr
See Also
Source
Rosen's