Beta-blocker overdose - NYSORA

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Beta-blocker overdose

Learning objectives

  • Diagnose and treat beta-blocker overdose

Definition and mechanisms

  • Beta-blockers are a type of medicine used to treat high blood pressure and heart rhythm disturbances
  • Also used in the treatment of thyroid disease, migraine, and glaucoma
  • Isolated beta-blocker overdose is usually benign
  • Two beta-blockers require special consideration because of cardiac instability:
    • Propanolol -> causes sodium channel blockade -> QRS widening -> treat with NaHCO3
    • Sotalol -> causes potassium efflux blockade -> long QT -> monitor for Torsades
  • Beta-blockers competitively block beta-1 and beta-2 receptors
  • Results in decreased production of intracellular cyclic adenosine monophosphate (cAMP) with a resultant blunting of multiple metabolic and cardiovascular effects of circulating catecholamines
    • In therapeutic doses, this leads to a reduced heart rate and blood pressure
    • An overdose causes the heart to enter a shock state
  • Comorbid disease (CAD, CHF, atrial fibrillation, dysrhythmias, HOCM)

Signs and symptoms

  • Proportional to the type and amount ingested
Respiratory systemBronchospasm
Visual systemBlurred vision
Double vision
Cardiovascular systemHypotension
AV block
Heart failure
Metabolic systemHypoglycemia
Nervous systemWeakness
Excessive sweating


beta-blocker overdose, bradycardia, propranolol, sotalol, activated charcoal, ECG, glucagon, insulin

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Suggested reading

  • Shepherd G. Treatment of poisoning caused by beta-adrenergic and calcium-channel blockers. Am J Health Syst Pharm. 2006;63(19):1828-1835.

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