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Toxicity, Beta-blocker: Differential Diagnoses & Workup

Author: Adhi Sharma, MD, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Chairman, Department of Emergency Medicine, Good Samaritan Hospital Medical Center; Medical Toxicology Consultant, New York City Department of Health and Poison Control Center
Coauthor(s): Lemeneh Tefera, MD, FAAEM, Attending Physician, Department of Emergency Medicine, Beth Israel Medical Center; Aman Aminzay, MD, Resident, Department of Emergency Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Apr 21, 2009

Differential Diagnoses

Congestive Heart Failure and Pulmonary Edema
Shock, Hypovolemic
Epidural and Subdural Infections
Shock, Septic
Epidural Hematoma
Torsade de Pointes
Hyperkalemia
Toxicity, Antidepressant
Meningitis
Toxicity, Calcium Channel Blocker
Pediatrics, Hypoglycemia
Toxicity, Carbamazepine
Pediatrics, Meningitis and Encephalitis
Toxicity, Carbon Monoxide
Pediatrics, Sudden Infant Death Syndrome
Toxicity, Cocaine
Plant Poisoning, Glycosides - Cardiac
Shock, Cardiogenic
Shock, Hemorrhagic

Workup

Laboratory Studies

  • A bedside glucose (fingerstick) test should be performed. Beta-blockers may be associated with hypoglycemia, especially in patients with diabetes and in children.
  • Hypokalemia may contribute to cardiac arrhythmias.
  • Acidosis from poor cardiac perfusion may be manifested by low serum bicarbonate.
  • Co-ingestions or concomitant medical conditions may alter other serum electrolytes so these should be monitored closely, especially in patients with seizures or altered mental status.
  • Measure cardiac enzymes to rule out myocardial infarction in any hemodynamically unstable patient.
  • No studies have been performed to correlate the serum beta-blocker concentration with the outcome of beta-blocker overdose.
  • Blood gases (arterial or venous) analysis may be helpful for managing metabolic acidosis from seizures or cardiogenic shock or rare cases of severe bronchospasm, respiratory acidosis, or hypoxia.

Imaging Studies

  • In a severe overdose that impairs myocardial contraction, chest radiographs may show evidence of pulmonary edema.

Other Tests

  • Electrocardiography
    • ECG results after beta-blocker overdose may include progressively worsening sinus bradycardia, increased PR intervals, loss of atrial activity, atrioventricular junctional rhythm, widening of the QRS complex, atrioventricular block, idioventricular rhythm, and asystole.
    • A prolonged QT interval has been observed after sotalol overdose.
    • Ventricular fibrillation and ventricular tachycardia are uncommon because of the antidysrhythmic effects of most beta-blockers, with the exception of sotalol.

More on Toxicity, Beta-blocker

Overview: Toxicity, Beta-blocker
Differential Diagnoses & Workup: Toxicity, Beta-blocker
Treatment & Medication: Toxicity, Beta-blocker
Follow-up: Toxicity, Beta-blocker
Multimedia: Toxicity, Beta-blocker
References
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References

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Further Reading

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Keywords

beta-blocker toxicity, beta-blocker poisoning, beta-blocker overdose, beta-adrenergic antagonist overdose, beta-adrenergic antagonist toxicity, hypertension, postmyocardial infarction, migraine headaches, essential tremors, thyrotoxicosis, glaucoma, anxiety, propranolol, nadolol, timolol, pindolol, acebutolol, labetalol, sotalol, oxprenolol, practolol, esmolol, alprenolol, metoprolol, quinidinelike effects, Vaughan-Williams class I antiarrhythmic effects, QT interval prolongation, prolonged QT interval, multifocal premature ventricular contractions, PVCs, bigeminy, ventricular tachycardia, ventricular fibrillation, torsade de pointes, seizures, hypoglycemia

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Contributor Information and Disclosures

Author

Adhi Sharma, MD, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Chairman, Department of Emergency Medicine, Good Samaritan Hospital Medical Center; Medical Toxicology Consultant, New York City Department of Health and Poison Control Center
Adhi Sharma, MD is a member of the following medical societies: American College of Clinical Toxicologists, American College of Emergency Physicians, and American College of Medical Toxicology
Disclosure: Nothing to disclose.

Coauthor(s)

Lemeneh Tefera, MD, FAAEM, Attending Physician, Department of Emergency Medicine, Beth Israel Medical Center
Lemeneh Tefera, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Aman Aminzay, MD, Resident, Department of Emergency Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine
Aman Aminzay, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

David C Lee, MD, Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School
David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

John G Benitez, MD, MPH, FACMT, FACPM, FAAEM, Associate Professor, Department of Medicine, Clinical Pharmacology Division, Vanderbilt University; Managing Director, Tennessee Poison Center
John G Benitez, MD, MPH, FACMT, FACPM, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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