Management of Beta-Adrenergic Blocker Poisoning

Clinical Pediatric Emergency Medicine

Volumn 9, Issue 1, 2008, Pages 4-16

  Anderson, Angela C ^a,b  

^a HASBRO CHILDREN'S HOSPITAL   (United States)

^b BROWN UNIVERSITY   (United States)

Author keywords

blockers; cardiovascular agents; overdose; poisoning

Indexed keywords

ACEBUTOLOL; ADRENALIN; AMINOPHYLLINE; ATENOLOL; ATROPINE; BETA ADRENERGIC RECEPTOR; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BETAXOLOL; BISOPROLOL; CALCIUM; CARTEOLOL; CARVEDILOL; DOBUTAMINE; DOPAMINE; ESMOLOL; GLUCAGON; GLUCOSE; LABETALOL; METOPROLOL; NADOLOL; NEBIVOLOL; OXPRENOLOL; PENBUTOLOL; PINDOLOL; POTASSIUM; POTASSIUM CHANNEL; PROPRANOLOL; SOTALOL; TIMOLOL; UNINDEXED DRUG;

ANGINA PECTORIS; ANXIETY DISORDER; AORTA BALLOON; ARTICLE; ATRIOVENTRICULAR BLOCK; BEHAVIOR DISORDER; BRADYCARDIA; BRONCHOSPASM; CARDIOTOXICITY; CARDIOVASCULAR DISEASE; CHILD; CONTINUOUS INFUSION; DRUG ABSORPTION; DRUG BIOAVAILABILITY; DRUG DISTRIBUTION; DRUG ELIMINATION; DRUG HALF LIFE; DRUG INTOXICATION; DRUG METABOLISM; DRUG OVERDOSE; DRUG PROTEIN BINDING; DRUG SELECTIVITY; DRUG SOLUBILITY; ECG ABNORMALITY; EXTRACORPOREAL CIRCULATION; GLUCOSE TRANSPORT; HEADACHE; HEART ARRHYTHMIA; HEART FAILURE; HEART MUSCLE; HEART PACING; HEART VENTRICLE TACHYCARDIA; HEMODIALYSIS; HUMAN; HYPERKALEMIA; HYPERTENSION; HYPOGLYCEMIA; HYPOTENSION; INTRINSIC SYMPATHOMIMETIC ACTIVITY; MEMBRANE STABILIZATION; MIGRAINE; MOOD DISORDER; MORTALITY; NEUROTOXICITY; PATHOPHYSIOLOGY; PATIENT MONITORING; PRESCRIPTION; PROTEIN LOCALIZATION; RESPIRATION DEPRESSION; SEIZURE; SLEEP DISORDER; SMOOTH MUSCLE; STOMACH LAVAGE; TORSADE DES POINTES; VASODILATATION; VASOSPASM; VOMITING;

EID: 40249084197     PISSN: 15228401     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.cpem.2007.12.001     Document Type: Article

References (103)

1. Lai M.W., Klein-Schwartz W., Rodgers G.C., et al. 2005 Annual report of the American Association of Poison Control Centers' national poisoning and exposure database. Clin Toxicol 44 (2006) 803-932
2. Kendall M.J., Dean S., Bradley D., et al. Cardiovascular and metabolic effects of terbutaline. J Clin Hosp Pharm 7 (1982) 31-36
3. Kendall M.J., Lewis H.M., Haffner C.A., et al. Investigation of the beta 2-agonist properties of dilevalol: metabolic effects of intravenous infusion. J Hum Hypertens 4 Suppl 2 (1990) 65-68
4. Kendall M.J., Hafner C.A., Hughes B., et al. The adrenergic control of lipolysis: development of tolerance to beta-2 receptor stimulation with terbutaline. Clin Chim Acta 204 (1991) 51-55
5. Tavernier G., Toumaniantz G., Erfanian M., et al. beta3-Adrenergic stimulation produces a decrease of cardiac contractility ex vivo in mice overexpressing the human beta3-adrenergic receptor. Cardiovasc Res 59 (2003) 288-296
6. Osawa S., Heasley L.E., Dhanasekaran N., et al. Mutation of the Gs protein alpha subunit NH2 terminus relieves an attenuator function, resulting in constitutive adenylyl cyclase stimulation. Mol Cell Biol 10 (1990) 2931-2940
7. Kaumann A.J. Four beta-adrenoceptor subtypes in the mammalian heart. Trends Pharmacol Sci 18 (1997) 70-76
8. Kendall M.J. Do we need a new classification of beta-blockers?. J Hum Hypertens 4 Suppl 2 (1990) 27-29
9. Salpeter S.R., Ormiston T.M., Salpeter E.E., et al. Cardioselective beta-blockers for chronic obstructive pulmonary disease: a meta-analysis. Respir Med 97 (2003) 1094-1101
10. Pedersen M.E., and Cockcroft J.R. The latest generation of beta-blockers: new pharmacologic properties. Curr Hypertens Rep 8 (2006) 279-286
11. Brody G. Type II antidysrhythmic agents (beta-receptor blocking agents). In: Dart R. (Ed). Medical toxicology (2004), Lippincott Williams & Wilkins, Philadelphia 679-689
12. Hollander J.E. The management of cocaine-associated myocardial ischemia. N Engl J Med 333 (1995) 1267-1272
13. Boehrer J.D., Moliterno D.J., Willard J.E., et al. Influence of labetalol on cocaine-induced coronary vasoconstriction in humans. Am J Med 94 (1993) 608-610
14. Jasper J.R., Michel M.C., and Insel P.A. Molecular mechanism of beta-adrenergic receptor blockers with intrinsic sympathomimetic activity. FASEB J 2 (1988) 2891-2894
15. Kostis J.B., and Rosen R.C. Central nervous system effects of beta-adrenergic-blocking drugs: the role of ancillary properties. Circulation 75 (1987) 204-212
16. Black C.D., and Mann H.J. Intrinsic sympathomimetic activity: physiological reality or marketing phenomenon. Drug Intell Clin Pharm 18 (1984) 554-559
17. Kaumann A.J., and Molenaar P. Modulation of human cardiac function through 4 beta-adrenoceptor populations. Naunyn Schmiedebergs Arch Pharmacol 355 (1997) 667-681
18. Joseph S.S., Lynham J.A., Molenaar P., et al. Intrinsic sympathomimetic activity of (-)-pindolol mediated through a (-)-propranolol-resistant site of the beta1-adrenoceptor in human atrium and recombinant receptors. Naunyn Schmiedebergs Arch Pharmacol 368 (2003) 496-503
19. Love J.N. Acebutolol overdose resulting in fatalities. J Emerg Med 18 (2000) 341-344
20. Ramos K., Melchert R., Chacon E., and Acosta D. Toxic responses of the heart and vascular systems. In: Casarett L.J., Doull J., and Klaassen C.D. (Eds). The basic science of poisons. 6th ed. (2001), McGraw-Hill Medical Pub. Division, New York 597-651
21. DeWitt C.R., and Waksman J.C. Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity. Toxicol Rev 23 (2004) 223-238
22. Brubacher J. Beta adrenergenic antagonists. In: Goldfrank L.R. (Ed). Goldfrank's toxicologic emergencies. 7th ed. (2002), McGraw-Hill Medical Pub. Division, New York 741-757
23. Delk C., Holstege C.P., and Brady W.J. Electrocardiographic abnormalities associated with poisoning. Am J Emerg Med 25 (2007) 672-687
24. Shanker U.R., Webb J., and Kotze A. Sodium bicarbonate to treat massive beta blocker overdose. Emerg Med J 20 (2003) 393
25. Donovan K.D., Gerace R.V., and Dreyer J.F. Acebutolol-induced ventricular tachycardia reversed with sodium bicarbonate. J Toxicol Clin Toxicol 37 (1999) 481-484
26. Neuvonen P.J., Elonen E., Vuorenmaa T., et al. Prolonged Q-T interval and severe tachyarrhythmias, common features of sotalol intoxication. Eur J Clin Pharmacol 20 (1981) 85-89
27. Assimes T.L., and Malcolm I. Torsade de pointes with sotalol overdose treated successfully with lidocaine. Can J Cardiol 14 (1998) 753-756
28. Alderfliegel F., Leeman M., Demaeyer P., et al. Sotalol poisoning associated with asystole. Intensive Care Med 19 (1993) 57-58
29. Montagna M., and Groppi A. Fatal sotalol poisoning. Arch Toxicol 43 (1980) 221-226
30. Yalta K., Turgut O., Yilmaz A., et al. Torsades de pointes with a severely prolonged QT interval induced by an initial low dose sotalol intake. Int J Cardiol 116 (2007) e95-e97
31. Farhangi V., and Sansone R.A. QTc prolongation due to propranolol overdose. Int J Psychiatry Med 33 (2003) 201-202
32. Love J.N., Enlow B., Howell J.M., et al. Electrocardiographic changes associated with beta-blocker toxicity. Ann Emerg Med 40 (2002) 603-610
33. Love J.N., Howell J.M., Litovitz T.L., et al. Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity. J Toxicol Clin Toxicol 38 (2000) 275-281
34. Reith D.M., Dawson A.H., Epid D., et al. Relative toxicity of beta blockers in overdose. J Toxicol Clin Toxicol 34 (1996) 273-278
35. Montgomery A.B., Stager M.A., and Schoene R.B. Marked suppression of ventilation while awake following massive ingestion of atenolol. Chest 88 (1985) 920-921
36. Love J.N., and Elshami J. Cardiovascular depression resulting from atenolol intoxication. Eur J Emerg Med 9 (2002) 111-114
37. Langemeijer J.J., de Wildt D.J., de Groot G., et al. Central origin of respiratory arrest in beta-blocker intoxication in rats. Toxicol Appl Pharmacol 89 (1987) 399-407
38. Fischer W. Anticonvulsant profile and mechanism of action of propranolol and its two enantiomers. Seizure 11 (2002) 285-302
39. Fischer W., Lasek R., and Muller M. Anticonvulsant effects of propranolol and their pharmacological modulation. Pol J Pharmacol Pharm 37 (1985) 883-896
40. Amabeoku G.J., and Syce J.A. Propranolol-induced seizures in mice: the role of noradrenaline. Cell Mol Life Sci 53 (1997) 646-651
41. Wallin C.J., and Hulting J. Massive metoprolol poisoning treated with prenalterol. Acta Med Scand 214 (1983) 253-255
42. Das G., and Ferris J.C. Generalized convulsions in a patient receiving ultrashort-acting beta-blocker infusion. Drug Intell Clin Pharm 22 (1988) 484-485
43. Maebara C., Ohtani H., Sugahara H., et al. Nightmares and panic disorder associated with carvedilol overdose. Ann Pharmacother 36 (2002) 1736-1740
44. Love J.N. Beta-blocker toxicity: a clinical diagnosis. Am J Emerg Med 12 (1994) 356-357
45. Frishman W., Jacob H., Eisenberg E., et al. Clinical pharmacology of the new beta-adrenergic blocking drugs. Part 8. Self-poisoning with beta-adrenoceptor blocking agents: recognition and management. Am Heart J 98 (1979) 798-811
46. Weinstein R.S., Cole S., Knaster H.B., et al. Beta blocker overdose with propranolol and with atenolol. Ann Emerg Med 14 (1985) 161-163
47. Salpeter S., Ormiston T., and Salpeter E. Cardioselective beta-blocker use in patients with reversible airway disease. Cochrane Database Syst Rev (2001) CD002992
48. Pettei M.J., Levy J., and Abramson S. Nonocclusive mesenteric ischemia associated with propranolol overdose: implications regarding splanchnic circulation. J Pediatr Gastroenterol Nutr 10 (1990) 544-547
49. Bird S. Beta adrenerigic antagonists. In: Shannon M., Borron S., and Burns M. (Eds). Haddad and Winchester's clinical management of poisoning and drug overdose. 4th ed. (2007), Saunders Elsevier, Philadelphia (Pa) 975-982
50. Haffner C.A., and Kendall M.J. Metabolic effects of beta 2-agonists. J Clin Pharm Ther 17 (1992) 155-164
51. Hamad A., Salameh M., Zihlif M., et al. Life-threatening hyperkalemia after intravenous labetolol injection for hypertensive emergency in a hemodialysis patient. Am J Nephrol 21 (2001) 241-244
52. Bell D.S. Advantages of a third-generation beta-blocker in patients with diabetes mellitus. Am J Cardiol 93 (2004) B49-B52
53. Eibs H.G., Oberdisse U., and Brambach U. Intoxication by beta-blockers in children and adolescents. Monatsschr Kinderheilkd 130 (1982) 292-295
54. Love J.N., and Sikka N. Are 1-2 tablets dangerous? Beta-blocker exposure in toddlers. J Emerg Med 26 (2004) 309-314
55. Love J.N., Howell J.M., Klein-Schwartz W., et al. Lack of toxicity from pediatric beta-blocker exposures. Hum Exp Toxicol 25 (2006) 341-346
56. Link M.S., Foote C.B., Sloan S.B., et al. Torsade de pointes and prolonged QT interval from surreptitious use of sotalol: use of drug levels in diagnosis. Chest 112 (1997) 556-557
57. Vale J.A., and Kulig K. Position paper: gastric lavage. J Toxicol Clin Toxicol 42 (2004) 933-943
58. Soni N., Baines D., and Pearson I.Y. Cardiovascular collapse and propranolol overdose. Med J Aust 2 (1983) 629-630
59. Krenzelok E.P. Ipecac syrup-induced emesis...no evidence of benefit. Clin Toxicol (Phila) 43 (2005) 11-12
60. Manoguerra A.S., and Cobaugh D.J. Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons. Clin Toxicol (Phila) 43 (2005) 1-10
61. Wax P.M., Erdman A.R., Chyka P.A., et al. beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 43 (2005) 131-146
62. Karkkainen S., and Neuvonen P.J. Effect of oral charcoal and urine pH on sotalol pharmacokinetics. Int J Clin Pharmacol Ther Toxicol 22 (1984) 441-446
63. Position paper: whole bowel irrigation. J Toxicol Clin Toxicol 42 (2004) 843-854
64. Kerns W. Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am 25 (2007) 309-331
65. Rooney M., Massey K.L., Jamali F., et al. Acebutolol overdose treated with hemodialysis and extracorporeal membrane oxygenation. J Clin Pharmacol 36 (1996) 760-763
66. Saitz R., Williams B.W., and Farber H.W. Atenolol-induced cardiovascular collapse treated with hemodialysis. Crit Care Med 19 (1991) 116-118
67. Salhanick S.D., and Wax P.M. Treatment of atenolol overdose in a patient with renal failure using serial hemodialysis and hemoperfusion and associated echocardiographic findings. Vet Hum Toxicol 42 (2000) 224-225
68. Strubelt O. Evaluation of antidotes against the acute cardiovascular toxicity of propranolol. Toxicology 31 (1984) 261-270
69. Langemeijer J., de Wildt D., de Groot G., et al. Calcium interferes with the cardiodepressive effects of beta-blocker overdose in isolated rat hearts. J Toxicol Clin Toxicol 24 (1986) 111-133
70. Love J.N., Hanfling D., and Howell J.M. Hemodynamic effects of calcium chloride in a canine model of acute propranolol intoxication. Ann Emerg Med 28 (1996) 1-6
71. Pertoldi F., D'Orlando L., and Mercante W.P. Electromechanical dissociation 48 hours after atenolol overdose: usefulness of calcium chloride. Ann Emerg Med 31 (1998) 777-781
72. Glick G., Parmley W.W., Wechsler A.S., et al. Glucagon. Its enhancement of cardiac performance in the cat and dog and persistence of its inotropic action despite beta-receptor blockade with propranolol. Circ Res 22 (1968) 789-799
73. Kosinski E.J., and Malindzak G.S. Glucagon and isoproterenol in reversing propranolol toxicity. Arch Intern Med 132 (1973) 840-843
74. Kerns W., Schroeder D., Williams C., et al. Insulin improves survival in a canine model of acute beta-blocker toxicity. Ann Emerg Med 29 (1997) 748-757
75. Love J.N., Leasure J.A., Mundt D.J., et al. A comparison of amrinone and glucagon therapy for cardiovascular depression associated with propranolol toxicity in a canine model. J Toxicol Clin Toxicol 30 (1992) 399-412
76. Sato S., Tsuji M.H., Okubo N., et al. Milrinone versus glucagon: comparative hemodynamic effects in canine propranolol poisoning. J Toxicol Clin Toxicol 32 (1994) 277-289
77. Manchester J.H., Parmley W.W., Matloff J.M., et al. Effects of glucagon on myocardial oxygen consumption and coronary blood flow in man and in dog. Circulation 41 (1970) 579-588
78. Toet A.E., Wemer J., Vleeming W., et al. Experimental study of the detrimental effect of dopamine/glucagon combination in d,l-propranolol intoxication. Hum Exp Toxicol 15 (1996) 411-421
79. Parmley W.W., Glick G., and Sonnenblick E.H. Cardiovascular effects of glucagon in man. N Engl J Med 279 (1968) 12-17
80. Zaloga G.P., DeLacey W., Holmboe E., et al. Glucagon reversal of hypotension in a case of anaphylactoid shock. Ann Intern Med 105 (1986) 65-66
81. Chernow B., Zaloga G.P., Malcolm D., et al. Glucagon's chronotropic action is calcium dependent. J Pharmacol Exp Ther 241 (1987) 833-837
82. Yao L.F., MacLeod K.M., and McNeill J.H. Glucagon-induced densensitization: correlation between cyclic AMP levels and contractile force. Eur J Pharmacol 79 (1982) 147-150
83. White C.M. A review of potential cardiovascular uses of intravenous glucagon administration. J Clin Pharmacol 39 (1999) 442-447
84. Burda A.M., and Kapustka C.A. Reformulated glucagon diluent phenol-free. J Toxicol Clin Toxicol 37 (1999) 127
85. Masters T.N., and Glaviano V.V. The effects of norepinephrine and propranolol on myocardial subcellular distribution of triglycerides and free fatty acids. J Pharmacol Exp Ther 182 (1972) 246-255
86. Masters T.N., and Glaviano V.V. Effects of dl-propranolol on myocardial free fatty acid and carbohydrate metabolism. J Pharmacol Exp Ther 167 (1969) 187-193
87. Liang C., Doherty J.U., Faillace R., et al. Insulin infusion in conscious dogs. Effects on systemic and coronary hemodynamics, regional blood flows, and plasma catecholamines. J Clin Invest 69 (1982) 1321-1336
88. Van den Berghe G. How does blood glucose control with insulin save lives in intensive care?. J Clin Invest 114 (2004) 1187-1195
89. Holger J.S., Engebretsen K.M., Fritzlar S.J., et al. Insulin versus vasopressin and epinephrine to treat beta-blocker toxicity. Clin Toxicol (Phila) 45 (2007) 396-401
90. Kerns W., Ransom M., Tomaszewski C., et al. The effects of extracellular ions on beta-blocker cardiotoxicity. Toxicol Appl Pharmacol 137 (1996) 1-7
91. Van den Berghe G., Wouters P.J., Bouillon R., et al. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31 (2003) 359-366
92. van den Berghe G., Wouters P., Weekers F., et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 345 (2001) 1359-1367
93. Weinstein R.S. Recognition and management of poisoning with beta-adrenergic blocking agents. Ann Emerg Med 13 (1984) 1123-1131
94. Shore E.T., Cepin D., and Davidson M.J. Metoprolol overdose. Ann Emerg Med 10 (1981) 524-527
95. Lewis M., Kallenbach J., Germond C., et al. Survival following massive overdose of adrenergic blocking agents (acebutolol and labetalol). Eur Heart J 4 (1983) 328-332
96. Critchley J.A., and Ungar A. The management of acute poisoning due to beta-adrenoceptor antagonists. Med Toxicol Adverse Drug Exp 4 (1989) 32-45
97. Prichard B.N., Battersby L.A., and Cruickshank J.M. Overdosage with beta-adrenergic blocking agents. Adverse Drug React Acute Poisoning Rev 3 (1984) 91-111
98. Whitehurst V.E., Vick J.A., Alleva F.R., et al. Reversal of propranolol blockade of adrenergic receptors and related toxicity with drugs that increase cyclic AMP. Proc Soc Exp Biol Med 221 (1999) 382-385
99. Arstall M.A., Hii J.T., Lehman R.G., et al. Sotalol-induced torsade de pointes: management with magnesium infusion. Postgrad Med J 68 (1992) 289-290
100. Lane A.S., Woodward A.C., and Goldman M.R. Massive propranolol overdose poorly responsive to pharmacologic therapy: use of the intra-aortic balloon pump. Ann Emerg Med 16 (1987) 1381-1383
101. McVey F.K., and Corke C.F. Extracorporeal circulation in the management of massive propranolol overdose. Anaesthesia 46 (1991) 744-746
102. Kenyon C.J., Aldinger G.E., Joshipura P., et al. Successful resuscitation using external cardiac pacing in beta adrenergic antagonist-induced bradyasystolic arrest. Ann Emerg Med 17 (1988) 711-713
103. Love J.N. Beta blocker toxicity after overdose: when do symptoms develop in adults?. J Emerg Med 12 (1994) 799-802