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Beta-blocker overdose — SCE Acute Medicine MCQ

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HardToxicology and OverdoseBeta-blocker overdoseSCE Acute Medicine

A 55-year-old man is assessed on the acute medical unit. He has taken propranolol and presents with bradycardia, hypotension and hypoglycaemia. Fluids and atropine have not corrected shock. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: E — Give high-dose insulin euglycaemic therapy after specialist advice

Give high-dose insulin euglycaemic therapy after specialist advice is the best answer because refractory beta-blocker toxicity may require high-dose insulin therapy under expert guidance. Insert a large-bore chest drain using image guidance is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Propranolol also causes sodium-channel blockade and seizures in severe overdose.

Reference: Toxbase; BNF