Accidental or intentional overdose of a beta-blocker can result in a number of cardiovascular problems which can be life-threatening. The selectivity of the agent will determine the symptoms that are seen.
Clinical findings in overdosage with a beta-blocking agent:
(1) hypotension
(2) bradycardia with atrioventricular block and widened QRS complexes
(3) ventricular tachyarrhythmias
(4) hypoglycemia (uncommon)
(5) seizures
(6) stupor or coma
(7) respiratory depression
(8) bronchospasm (with pre-existing lung disease)
(9) cardiogenic shock
Management:
(1) glucagon (drug of choice; enhances cardiac contractility and reverses negative inotropic and chronotropic effects)
(2) fluid resuscitation
(3) calcium chloride infusion
(4) bradycardia may require atropine or temporary ventricular pacing
(5) pressor amines (isoproterenol, dopamine, epinephrine) have been used but often require high doses
(6) phosphodiesterase inhibitors
(7) cardiogenic shock may require intra-aortic balloon pump or cardiopulmonary bypass
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