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Beta-blocker toxicity – glucagon — RACP Paediatrics MCQ

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HardEmergencyBeta-blocker toxicity – glucagonRACP Paediatrics

A 2-year-old has ingested an unknown number of grandmother's metoprolol tablets. He is bradycardic (HR 45), hypotensive (BP 55/30), and drowsy. Blood glucose is 2.0 mmol/L. What is the specific treatment for beta-blocker toxicity?

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Correct answer: B — Beta-blocker overdose management

Beta-blocker overdose causes bradycardia, hypotension, and hypoglycaemia (due to impaired gluconeogenesis and glycogenolysis). Specific treatment includes: IV glucagon (first-line specific antidote – stimulates cAMP production independent of beta-receptors), IV atropine for bradycardia, IV dextrose for hypoglycaemia, and vasopressors if needed. High-dose insulin-euglycaemia therapy (HIET) may be used in refractory cases.

Reference: RCH Melbourne – 2023 – Poisoning CPG; Australian Therapeutic Guidelines – 2024 – Toxicology