Back to Basics: Beta Blocker & Calcium Channel Blocker Overdose Treatment
Beta-blocker (BB) and Calcium Channel Blocker (CCB) Overdose Treatment
Author: Valeria Chew
Treatment: ABCs!
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BBs |
CCBs |
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charcoal (if <1 hr) |
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glucacon · Bolus 3-10mg IV, infusion 1-5 mg / hr · children: bolus 30-150 ug, infusion 30-150 ug / hr |
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adrenergic agonist · norepi, epi, phenylephrine |
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high dose insulin · bolus 1 U / kg, infusion 1 U / kg / hour · GIVE DEXTROSE! watch your potassium |
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calcium chloride / gluconate |
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lipid emulsion therapy |
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cardiac pacing |
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ECMO |
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psychiatric consult for suicidality if concern |
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toxicology consult |
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ICU depending on severity |
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phosphodiesterase inhibitors / milrinone · bolus 50 u / kg, infusion 0.4 - 0.7 u / kg / hr |
atropine for bradycardia |
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sodium bicarbonate · 3 - 4 amps for QRS > 120 |
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hemodialysis |
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Resources
Kerns W: Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am 25: 309, 2007.
Riddle MK, Tomaszewski C. Beta-Blockers. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e.
Litovitz TL, Schmitz BF, Holm KC: 1988 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 7: 495, 1989.
Masom C.P., & Tomaszewski C (2020). Calcium channel blockers. In: Tintinalli J.E., & Ma O, & Yealy D.M., & Meckler G.D., & Stapczynski J, & Cline D.M., & Thomas S.H.(Eds.), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e.