![]() Intravenous dextrose bolus should not be administered if the glucose level is more than 400 mg/dL. In general, 1 U/kg of regular insulin bolus along with 0.5 g/kg dextrose intravenously (IV) is administered. Potassium and glucose should, therefore, be checked before initiation of high-dose insulin, euglycemia. High-dose insulin, euglycemia is a safe and simple way to augment cardiac contractility and does not need invasive monitoring. High-dose insulin, euglycemia can cause profound hypokalemia and hypoglycemia that can potentiate the cardiotoxicity in the setting of beta-blocker overdose. Cases refractory to fluids, atropine, and glucagon should be considered candidates for high-dose insulin, euglycemia (HIE) treatment. Treatment with calcium salts may provide benefits for hypotensive patients who overdosed on beta-blockers alone or in combination with a calcium channel blocker. Other possible side effects of glucagon include hypocalcemia and hyperglycemia. Premedication with antiemetic may be considered since treatment with glucagon may induce vomiting. Although there have been no controlled trials to prove the efficacy of glucagon in poisoning beta-blocker overdose, glucagon is considered as a useful treatment of choice. Prompt recognition of QRS widening and prolongation of QTc interval is crucial.Īdminister sodium bicarbonate for QRS widening and magnesium sulfate for QTc prolongation. ![]() ![]() Benzodiazepines are the first line of treatment for seizures that may occur due to the high lipophilicity of certain beta-blockers. Consider whole bowel irrigation with polyethylene glycol sustained-release preparation and continued until the rectal effluent is clear. Gastrointestinal decontamination with gastric lavage may be necessary for patients who present shortly after massive ingestions and/or with serious symptoms.Īdminister activated charcoal to limit drug absorption to patients with minor symptoms who present later than an hour after ingestion. Bronchospasm due to beta-blockade may be treated with supplemental oxygen and inhaled bronchodilators like albuterol. Premedication with atropine may be necessary especially in children since laryngeal manipulation during intubation may cause additive vagal stimulation and bradycardia. The airway should be protected with a cuffed endotracheal tube in all deeply obtunded patients. Prompt management of the airway is, therefore crucial. Due to intrinsic lipophilicity, certain beta-blockers may cause CNS depression.
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