This handout is for beta-blocker overdose. Your care team identified this based on: reported / suspected beta-blocker ingestion or polypharmacy overdose (aact/acmt 2023).
Other reasons your team may use this plan: bradycardia + hypotension without obvious cardiac cause (critical-care tox review 2024); hypoglycemia with bradycardia/hypotension — bb pattern (engebretsen 2011); ams / seizure with bradycardia — lipophilic bb (propranolol) suspicion (kerns 2007).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| normal saline (isotonic crystalloid) | 10–20 mL/kg IV bolus (cautious — repeat to perfusion, avoid pulmonary edema in BB-induced cardiogenic shock) | IV | bolus, reassess | First-line volume support; limited efficacy in pump failure — escalate early rather than over-resuscitate (AACT/ACMT 2023) |
| atropine | 0.5–1 mg IV (peds 0.02 mg/kg, min 0.1 mg) q3–5 min, max 3 mg | IV | q3–5 min PRN | Temporizing for vagally-mediated bradycardia; frequently inadequate alone in significant BB poisoning — do not delay HIET/pressors (critical-care tox review 2024) |
| activated charcoal | 1 g/kg PO/NG (max 50 g) | PO/NG | single dose | Only if early and airway protected — caution with declining mental status (lipophilic propranolol) (AACT/ACMT 2023) |
| whole-bowel irrigation (polyethylene glycol) | PEG-ELS 1–2 L/h (peds 25 mL/kg/h) until rectal effluent clear | PO/NG | continuous | Sustained/extended-release BB — reduces ongoing absorption; protect airway and exclude ileus first (AACT/ACMT 2023) |
Plan: Beta-blocker overdose — stepwise resuscitation ladder (fluids/atropine → HIET → vasopressors → glucagon → lipid emulsion → mechanical support)
Call 911 or go to the nearest emergency room right away if you have:
Observation period satisfied (≥6 h immediate-release with normal ECG; ≥24 h for sustained-release / sotalol / propranolol); psychiatric evaluation and safety plan if intentional; poison-prevention counseling for pediatric exploratory ingestion; medication-reconciliation and safe-storage education (AACT/ACMT 2023)
Guideline: 2023–2025 critical-care toxicology reviews on beta-blocker / CCB cardiotoxicity; Engebretsen high-dose insulin euglycemia (HIET) evidence; AACT/ACMT position statements on HIET and lipid emulsion; Kerns toxicology of beta-blocker poisoning