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Severe beta-blocker overdose — SCE Acute Medicine MCQ

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HardToxicology and OverdoseSevere beta-blocker overdoseSCE Acute Medicine

A 57-year-old man taking propranolol is admitted after intentional overdose. He has bradycardia, hypotension, recurrent hypoglycaemia and QRS is narrow. Fluids and atropine have not restored perfusion. What is the most appropriate escalation?

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Correct answer: D — Seek toxicology advice and start high-dose insulin euglycaemic therapy with vasopressor support

Severe beta-blocker poisoning with shock refractory to initial measures may require high-dose insulin euglycaemic therapy, vasopressors and critical care. Adenosine is for specific supraventricular tachycardias, not toxic bradycardic shock. Correcting glucose alone does not treat myocardial depression. Toxicology input is important because lipid emulsion or extracorporeal support may be considered in selected cases.

Reference: TOXBASE beta-blocker poisoning, BNF