If this fails to correct the hypotension, beta-selective pressers such as dobutamine and isoproterenol may help, but carry the risk of paroxysmal hypotension due to the high doses that are often required (Nelson et al. Hypoglycemia is coming in these patients, so make sure that highly concentrated (≥5% dextrose solutions) glucose is given before the insulin. High dose insulin therapy (1U/kg/hr) with high dose glucose (0.5g/kg/hr) is thought by some to be first line for beta blocker overdose (Nelson et al. There are a few main-stays of treatment, all of which try to counteract the drugs activity at the cell. This leads to low heart rate and blood pressure, as well as an increased probability of sinus bradycardia on ECG. Beta Blockerīeta blockers (such as metoprolol, propranolol, carvedilol) interfere with catecholamine effect on beta adrenergic receptors (principally Beta-1 on heart muscle cells) leading to a decreased heart rate and contractility (Yates & Manini 2012). Luckily, there are some classic ECG changes that will help clue to into what a patient may have overdosed on. You know something is wrong, and a quick review of his nursing home paper work gives you the answer: digoxin toxicity.įiguring out what medication is causing problem for an altered patient can be challenging for any physician.
Dry mucus membranes, mumbling to himself and not making sense, not responding to your questions, febrile, diaphoretic.
You walk back to triage with the tech to see a 86 year old male patient who looks unwell.
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