Beta Blockers Intoxication

Authors

  • Enrique Adalberto Medina Pérez Residente Post-Grado de pediatría UNAH-VS
  • Melissa Portillo *Pediatras intensivistas del Instituto Hondureño de Seguridad Social.
  • Linda Banegas *Pediatras intensivistas del Instituto Hondureño de Seguridad Social. https://orcid.org/0000-0003-3402-1531
  • Belinda Velásquez *Pediatras intensivistas del Instituto Hondureño de Seguridad Social.

Keywords:

Carvedilol, Beta Blockers, Bradycardia, Toxicity

Abstract

Beta-blocker intoxication is a rare clinical situation, closely related to major depressive disorders, with a higher prevalence in women. Severe episodes related to beta-blocker toxicity are classified as moderate to severe episodes. In the case of carvedilol with a toxic threshold of 50mg. Clinical Case: 16-year-old patient with a history of ingesting carvedilol at toxic levels and the only history of major depression. Discussion: Beta-blockers antagonize beta-adrenergic receptors, symptoms related to bradycardia and hypotension are common and can cause central nervous system involvement. Emergency treatment if the patient is captured in the first hour consists of performing a gastric lavage and applying activated charcoal. The use of crystalloids and the use of epinephrine or norepinephrine are proposed as first line management and in case of sustained bradycardia the use of atropine should be considered. Asymptomatic patients should be monitored for six hours

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Author Biographies

Enrique Adalberto Medina Pérez , Residente Post-Grado de pediatría UNAH-VS

1. Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28846217.
2. Palatnick W, Jelic T. Calcium channel blocker and beta blocker overdose, and digoxin toxicity management. Emerg Med Pract. 2020 Sep 15;22(Suppl 9):1-42. PMID: 33136356
3. Maharaj S, Seegobin K, Perez-Downes J, Bajric B, Chang S, Reddy P. Severe carvedilol toxicity without overdose - caution in cirrhosis. Clin Hypertens. 2017 Nov 30;23:25. doi: 10.1186/s40885-0170083-z. PMID: 29214053; PMCID: PMC5709975.
4. Maharaj, Satish et al. “Toxicidad grave de carvedilol sin sobredosis: precaución en cirrosis”. Hipertensión clínica vol. 23 25. 30 de noviembre de 2017, doi:10.1186/s40885-017-0083-z
5. Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, Baxter H, Bourke E, Wong A. Tratamiento para la intoxicación por betabloqueantes: una revisión sistemática. Clin Toxicol (Phila). 2020 octubre;58(10):943-983. doi: 10.1080/15563650.2020.1752918. Epub 2020 20 de abril. PMID: 32310006.
6. Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol. 2016 Mar;81(3):453-61. doi: 10.1111/bcp.12763. Epub 2015 Oct 30. PMID: 26344579; PMCID: PMC4767195.
7. Seegobin K, Maharaj S, Deosaran A, Reddy P. Severe beta blocker and calcium channel blocker overdose: Role of high dose insulin. Am J EmergMed. 2018 Apr;36(4):736.e5-736.e6. doi: 10.1016/j.ajem.2018.01.038. Epub 2018 Jan 10. PMID: 29331270
8. Krenz JR, Kaakeh Y. An Overview of Hyperinsulinemic-Euglycemic Therapy in Calcium Channel Blocker and β-blocker Overdose. Pharmacotherapy. 2018 Nov;38(11):1130-1142. doi: 10.1002/phar.2177. Epub 2018 Oct 4. PMID: 30141827.

Melissa Portillo, *Pediatras intensivistas del Instituto Hondureño de Seguridad Social.

1. Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28846217.
2. Palatnick W, Jelic T. Calcium channel blocker and beta blocker overdose, and digoxin toxicity management. Emerg Med Pract. 2020 Sep 15;22(Suppl 9):1-42. PMID: 33136356
3. Maharaj S, Seegobin K, Perez-Downes J, Bajric B, Chang S, Reddy P. Severe carvedilol toxicity without overdose - caution in cirrhosis. Clin Hypertens. 2017 Nov 30;23:25. doi: 10.1186/s40885-0170083-z. PMID: 29214053; PMCID: PMC5709975.
4. Maharaj, Satish et al. “Toxicidad grave de carvedilol sin sobredosis: precaución en cirrosis”. Hipertensión clínica vol. 23 25. 30 de noviembre de 2017, doi:10.1186/s40885-017-0083-z
5. Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, Baxter H, Bourke E, Wong A. Tratamiento para la intoxicación por betabloqueantes: una revisión sistemática. ClinToxicol (Phila). 2020 octubre;58(10):943-983. doi: 10.1080/15563650.2020.1752918. Epub 2020 20 de abril. PMID: 32310006.
6. Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol. 2016 Mar;81(3):453-61. doi: 10.1111/bcp.12763. Epub 2015 Oct 30. PMID: 26344579; PMCID: PMC4767195.
7. Seegobin K, Maharaj S, Deosaran A, Reddy P. Severe beta blocker and calcium channel blocker overdose: Role of high dose insulin. Am J EmergMed. 2018 Apr;36(4):736.e5-736.e6. doi: 10.1016/j.ajem.2018.01.038. Epub 2018 Jan 10. PMID: 29331270
8. Krenz JR, Kaakeh Y. An Overview of Hyperinsulinemic-Euglycemic Therapy in Calcium Channel Blocker and β-blocker Overdose. Pharmacotherapy. 2018 Nov;38(11):1130-1142. doi: 10.1002/phar.2177. Epub 2018 Oct 4. PMID: 30141827.

Linda Banegas, *Pediatras intensivistas del Instituto Hondureño de Seguridad Social.

1. Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28846217.
2. Palatnick W, Jelic T. Calcium channel blocker and beta blocker overdose, and digoxin toxicity management. Emerg Med Pract. 2020 Sep 15;22(Suppl 9):1-42. PMID: 33136356
3. Maharaj S, Seegobin K, Perez-Downes J, Bajric B, Chang S, Reddy P. Severe carvedilol toxicity without overdose - caution in cirrhosis. Clin Hypertens. 2017 Nov 30;23:25. doi: 10.1186/s40885-0170083-z. PMID: 29214053; PMCID: PMC5709975.
4. Maharaj, Satish et al. “Toxicidad grave de carvedilol sin sobredosis: precaución en cirrosis”. Hipertensión clínica vol. 23 25. 30 de noviembre de 2017, doi:10.1186/s40885-017-0083-z
5. Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, Baxter H, Bourke E, Wong A. Tratamiento para la intoxicación por betabloqueantes: una revisión sistemática. ClinToxicol (Phila). 2020 octubre;58(10):943-983. doi: 10.1080/15563650.2020.1752918. Epub 2020 20 de abril. PMID: 32310006.
6. Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol. 2016 Mar;81(3):453-61. doi: 10.1111/bcp.12763. Epub 2015 Oct 30. PMID: 26344579; PMCID: PMC4767195.
7. Seegobin K, Maharaj S, Deosaran A, Reddy P. Severe beta blocker and calcium channel blocker overdose: Role of high dose insulin. Am J EmergMed. 2018 Apr;36(4):736.e5-736.e6. doi: 10.1016/j.ajem.2018.01.038. Epub 2018 Jan 10. PMID: 29331270
8. Krenz JR, Kaakeh Y. An Overview of Hyperinsulinemic-Euglycemic Therapy in Calcium Channel Blocker and β-blocker Overdose. Pharmacotherapy. 2018 Nov;38(11):1130-1142. doi: 10.1002/phar.2177. Epub 2018 Oct 4. PMID: 30141827.

Belinda Velásquez, *Pediatras intensivistas del Instituto Hondureño de Seguridad Social.

1. Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28846217.
2. Palatnick W, Jelic T. Calcium channel blocker and beta blocker overdose, and digoxin toxicity management. Emerg Med Pract. 2020 Sep 15;22(Suppl 9):1-42. PMID: 33136356
3. Maharaj S, Seegobin K, Perez-Downes J, Bajric B, Chang S, Reddy P. Severe carvedilol toxicity without overdose - caution in cirrhosis. Clin Hypertens. 2017 Nov 30;23:25. doi: 10.1186/s40885-0170083-z. PMID: 29214053; PMCID: PMC5709975.
4. Maharaj, Satish et al. “Toxicidad grave de carvedilol sin sobredosis: precaución en cirrosis”. Hipertensión clínica vol. 23 25. 30 de noviembre de 2017, doi:10.1186/s40885-017-0083-z
5. Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, Baxter H, Bourke E, Wong A. Tratamiento para la intoxicación por betabloqueantes: una revisión sistemática. ClinToxicol (Phila). 2020 octubre;58(10):943-983. doi: 10.1080/15563650.2020.1752918. Epub 2020 20 de abril. PMID: 32310006.
6. Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol. 2016 Mar;81(3):453-61. doi: 10.1111/bcp.12763. Epub 2015 Oct 30. PMID: 26344579; PMCID: PMC4767195.
7. Seegobin K, Maharaj S, Deosaran A, Reddy P. Severe beta blocker and calcium channel blocker overdose: Role of high dose insulin. Am J EmergMed. 2018 Apr;36(4):736.e5-736.e6. doi: 10.1016/j.ajem.2018.01.038. Epub 2018 Jan 10. PMID: 29331270
8. Krenz JR, Kaakeh Y. An Overview of Hyperinsulinemic-Euglycemic Therapy in Calcium Channel Blocker and β-blocker Overdose. Pharmacotherapy. 2018 Nov;38(11):1130-1142. doi: 10.1002/phar.2177. Epub 2018 Oct 4. PMID: 30141827.

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Published

2025-12-10

How to Cite

Medina Pérez , E. A., Portillo, M., Banegas, L., & Velásquez, B. (2025). Beta Blockers Intoxication. Acta Pediátrica Hondureña, 12(2), 1279–1282. Retrieved from https://www.camjol.info/index.php/PEDIATRICA/article/view/21102

Issue

Vol. 12 No. 2 (2021): Non-occupational Post-exposure Prophylaxis for HIV

Section

Clinical Cases