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Beta-Blocker Poisoning, Emergency Medicine

Reviewed 06/2017



Normal Physiology

  • Cardiovascular: β1-receptors:

    • ATP converted to cAMP by adenyl cyclase with stimulation of β-receptors.

    • cAMP activates protein kinase, which phosphorylates proteins of ...


Signs and Symptoms

  • Cardiovascular:

    • Hypotension

    • Bradycardia

    • Cardiac conduction delays

    • Heart block

    • Heart failure

    • Electrical mechanical dissociation

    • Loss of β-selectivity in overdose settings

  • Neurologic...



  • Transport pills and pill bottles when overdose suspected.

Initial Stabilization/Therapy

  • ABCs:

    • Airway protection as indicated by mental status

    • Supplemental oxygen as needed

    • 0.9% NS IV ...



Admission Criteria

  • ICU admission for decreased level of consciousness or hemodynamic instability (bradycardia, conduction delays, hypotension)

  • Observation and monitoring for 24 hr f...

Pearls and Pitfalls

  • Consider β-blocker toxicity in patients who present with hypotension and bradycardia.

  • Wide complex QRS dysrhythmias should be treated with sodium bicarbonate.

Additional Reading

  • Harvey  MG, Cave  GR. Intralipid infusion ameliorates propranolol-induced hypotension in rabbits. J Med Toxicol.  2008;4:71–76.

  • Pfaender  M, Casetti  PG, Azzolini  M, et al. Suc...



971.3 Poisoning by sympatholytics [antiadrenergics] 


  • T44.7X1A Poisoning by beta-adrenocpt antagonists, accidental, init

  • T44.7X4A Poisoning by beta-adrenocpt antagonists, undetermined, ini...

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