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Beta-blocker toxicity

Definition
Beta-blocker toxicity refers to an overdose or excessive exposure to β-blocker medications.
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Pathophysiology
The pathophysiology of β-blocker toxicity involves the excessive blockade of β-adrenergic receptors. This blockade leads to a decrease in HR and myocardial workload.
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Epidemiology
The incidence of β-blocker toxicity is estimated at 5.1% among hospitalized patients with acute poisoning.
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Disease course
Clinically, patients with β-blocker toxicity often present with bradycardia, hypotension, and varying degrees of AV block. In severe cases, patients may experience life-threatening cardiogenic shock refractory to pharmacological interventions.
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Prognosis and risk of recurrence
The prognosis of β-blocker toxicity can range from mild to severe toxicity, depending on the amount of β-blocker ingested and the time elapsed before treatment.
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Key sources
The following summarized guidelines for the evaluation and management of beta-blocker toxicity are prepared by our editorial team based on guidelines from the American Heart Association (AHA 2023), the American Heart Association (AHA/HRS/ACC 2019), and the American Association of Poison Control Centers (AAPCC/AACT/ACMT 2005).
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Guidelines

1.Diagnostic investigations

Initial assessment: elicit history to determine the precise ingested dose of a β-blocker, the presence of coingestants and comorbidities in patients without evidence of self-harm.
B
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2.Medical management

Admission to emergency department: refer patients with stated or suspected self-harm or victims of a potentially malicious administration of β-blocker to an emergency department immediately, guided by local poison center procedures, regardless of the dose reported.
B
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3.Inpatient care

Inpatient monitoring
Monitor asymptomatic patients referred to healthcare facilities for the following durations after ingestion:
6 hours for an immediate-release product other than sotalol
8 hours for a sustained-release product
12 hours for sotalol
B
Do not obtain routine 24-hour inpatient monitoring in asymptomatic patients unintentionally ingested a sustained-release product.
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4.Therapeutic procedures

Temporary cardiac pacing: consider attempting electrical pacing in patients with β-blocker-induced bradycardia.
C

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5.Follow-up and surveillance

Outcome assessment: obtain follow-up calls depending on the specific circumstances to determine outcome at appropriate intervals for up to 12-24 hours based on the judgment of the poison center staff.
B