Beta-blocker OD
                           ===============
þ Rx
 - asymptomatic, long-acting: consider whole-bowel irrigation (repeated charcoal 
   with sorbitol)
 - symptomatic:
  + Glucagon, up to 10 mg IV
  + high-dose pressors
  + consider milrinone or imamrinone
  + consider hyperinsulinemia/euglycemia (BIG doses of insulin, 1 mg/kg, with 
    similar drip, plenty of glucose boluses and drip and frequent fingersticks
  
        Glucagon has been used adjunctively for treatment of severe
shock following cardiac arrest due to beta-blocker toxicity (1,2). It
is a protocol drug for beta-blocker overdose associated with hypotension.

        There have been rare reports of the sucessful use of
*aminophylline* in aystole. The rationale being that it antagonizes
high myocardial adenosine levels.  A recent animal study disputed
this finding, however.


H. Louzon MD


(1)

Kenyon CJ, Aldinger GE, Joshipura P, Zaid GJ
Successful resuscitation using external cardiac pacing in beta adrenergic
antagonist-induced bradyasystolic arrest. Ann Emerg Med 1988
Jul;17(7):711-3


ABSTRACT:

We present a case of attempted suicide by propranolol overdose presenting
as convulsions followed by bradyasystolic cardiopulmonary arrest
successfully managed by external transcutaneous pacing. Inotropic support
and the resulting clinical improvement permitted discontinuation of cardiac
pacing after 75 minutes. Pharmacologic management included glucagon late in
the patient's management when the persistent hypotension was established to
be due to beta adrenergic blockade. A serum propranolol level of 2,331
ng/mL verified the overdose. This is the first report of successful
transcutaneous pacing for beta adrenergic antagonist poisoning.


(2)


Tai YT, Lo CW, Chow WH, Cheng CH

Successful resuscitation and survival following massive overdose of
metoprolol.
Br J Clin Pract 1990 Dec;44(12):746-7
ABSTRACT:

A 23-year-old female was found unconscious and deteriorated rapidly to
cardiac asystole. Prolonged resuscitation was required, and she remained in
severe cardiogenic shock, despite high doses of positive inotropic agents.
Massive beta-adrenoceptor blocker overdose was suspected (and subsequently
confirmed). IV administration of glucagon was followed by prompt
haemodynamic improvement and recovery, illustrating the beneficial role of
glucagon in overwhelming beta-adrenoceptor blockade.