Beta Blocker OD - Toxicology

Question 1

In a beta blocker OD with hypotension refractory to fluids and unstable bradycardia what’s the first drug to attempt?

Answer 1

Atropine .5mg

Question 2

What type of insulin should be considered in a beta blocker OD?

Answer 2

Humulin R
1 u/kg bolus, followed by
0.5-2 u/kg/hr infusion

Question 3

What should be administered along side the insulin in a BB OD?

Answer 3

Dextrose 25g PRN q. 60 min, obtain blood glucose q. 15 min

Question 4

What infusion might be administered to draw out lipophilic beta blockers in an overdose?

Answer 4

Intralipid 20% therapy
1.5 mL/kg over 5 min bolus, can be repeated followed by a .25mL/kg infusion
Max dose 12 mL/kg

Question 5

When should you consider a sodium bicarbonate bolus in a beta blocker overdose?

Answer 5

If the QRS is > 0.12s or a wide-complex arrhythmia
Sodium bicarb 1-2 mEq/kg q/ 5 min prn