After being unsuccessfully treated with glucagon, atropine, dopamine, epinephrine, and norepinephrine, HIE and ILE were initiated at 100-IU (1-IU/kg) bolus of regular insulin, 100mL of dextrose 50%, and 150mL (1.5mL/kg) of 20% ILE while the patient remained in pulseless electrical activity (PEA). The patient become bradycardiac during the initial resuscitation and his hypotension worsened. Atrial fibrillation was revealed and his medical history was significant for methamphetamine abuse, persistent atrial fibrillation, nonischemic cardiomyopathy, and severe mitral valve regurgitation. Seizures: if prolonged or recurrent – bolus of benzodiazepine.Part of the Search for a drug monograph: GOĪ 59-year-old man presented to the emergency department approximately one hour after a self-reported ingestion of 7.5g of metoprolol tartrate and was treated for a sole-agent metoprolol overdose. Magnesium urgently for any patients with torsades, consider magnesium if prolonged QT prior to development of torsades. Sodium bicarbonate urgently for patient with QRS prolongation and/or severe metabolic acidosis in the lipophilic beta-blockers)Įxtracorporeal membrane oxygenation (ECMO) if unresponsive to above therapiesĬardiac arrest: be prepared for a long (i.e.
High dose Insulin Euglycaemic Therapy (HIET) Glucagon in adults 5-10mg bolus followed by infusion of 50-150 micrograms/kg/hour atenolol, bisoprolol, sotalol).īronchospasm: in overdose systemic effects often seen even with cardioselective beta-blockers.īradycardia: atropine 0.5-1.2 mg in adults if symptomatic, may require pacing. propranolol, metoprolol, carvedilol).ĬNS effects mild in hydrophilic agents (e.g. Sotalol: QT prolongation and increased risk torsade de pointes through mechanism of potassium channel blockade.ĭrowsiness, confusion, seizures, hallucinations, coma – seen with lipophilic beta-blockers (e.g. propranolol) – widening of QRS by blocking Na channels can progress to life-threatening arrhythmias. Clinical Features Of Overdose Cardiovascular:Īgents with membrane stabilising activity (e.g.
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