Beta-adrenergic blocking drug poisoning

Posted by Doctor Nguyen Ngoc Phuong Nam - Emergency Medicine Doctor - Emergency Department - Vinmec Central Park International General Hospital

Beta-blockers antagonize beta-adrenergic receptors and are used primarily in the treatment of hypertension, heart failure, tachyarrhythmias, and angina. In addition to cardiovascular disorders, beta-blockers are also used in the treatment of anxiety, migraines, glaucoma, tremors, hyperthyroidism, and many other disorders. There are beta-blockers on the market such as: Bisoprolol Metoprolol, Carteolol, Propranolol, Sotalol, Carvedilol, Labetalol... Due to their diversity and widely used in the treatment of cardiovascular diseases, leading to risk Poisoning occurs with drugs in this group due to overdose.

Who often has suspicious clinical signs? Subjects who have a history of cardiovascular disease, are using medications for treatment or people with suspicion of suicide take a large number of available cardiovascular drugs or drugs from family members.
Clinically, effects are usually seen within 6 hours of oral administration, with the exception of sotalol, which may have a slow and prolonged toxicity.
Heart: Bradycardia is one of the most common signs. Low blood pressure Ventricular arrhythmia: ventricular tachycardia, ventricular fibrillation leading to palpitations, syncope, cardiac arrest. Consciousness: Mental status changes, delirium, coma, convulsions (especially with propranolol) Other manifestations may include: hypoglycemia, bronchospasm, hypothermia. Sotalol has class III antiarrhythmic effects that can lead to QT prolongation, torsades de pointes and possibly ventricular fibrillation. Respiratory failure
Subclinical on electrocardiogram manifests :
PR long QT prolongation bradycardia with sotalol QRS dilatation with propanolol Other arrhythmias Blood sugar: hypoglycemia Increased blood creatinine Differential diagnosis:
Rhythm Symptomatic bradycardia: Cardiovascular, myocardial infarction (related to RCA), sinus node syndrome... Metabolic/endocrine/environmental: Hyperkalemia, hypothermia (Osborn waves on ECG), hypothyroidism, low blood sugar. Other Poisonings: Ca channel blockers, Digoxin toxicity, analgesics and narcotics, pesticide poisoning with phosphates, alcohol poisoning...

Management of airway, breathing and circulation, consider activated charcoal if available within 2 hours of ingestion
Symptomatic bradycardia
Atropine 0.5-1mg every 3-5 minutes up to 3mg Avoid atropine in cases of wide QRS complex bradycardia and consider epinephrine, dobutamine, dopamine, isoproterenol Consider percutaneous pacing versus intravenous infusion Low blood pressure: Rapid infusion with 0.9% Nacl or Ringerlactate Hypoglycaemia
Adults Glucose Infusion 50% Children : 2.5 mL/kg Glucose 10% For initial treatment ineffective, consider advanced treatment with treatments:
Glucagon Calcium High Dose Insulin and Glucose Bicarbonate Vasopressors Intravenous infusion with Lipid Hemodialysis ECMO To identify and diagnose Beta-adrenergic blocker toxicity requires coordination from family, patient, approach situation and clinical signs. . Poisoning can be severe and fatal due to delayed detection or too high a dose. Therefore, patients and relatives who are using the above drugs should pay attention to take the right dose, keep it out of reach of children or the elderly with symptoms of confusion or forgetfulness or other mental illnesses. When detecting signs of drug overdose should bring to the nearest medical agency.

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