Inderal overdose

Hey guys. Have you had your coffee? How’s the migraine? We have had a day with a back to back inderal overdose case in the emergency department. This is a quick 5 minute overview of Inderal treatment and management.

Overview: most commonly prescribed drugs for the treatment of various cardiac disorders, hyperthyroidism, migraine, glaucoma, and anxiety.

–sodium bicarbonate for QRS widening and magnesium sulfate for QTc prolongation

-Although no controlled trials to prove the efficacy of glucagon beta-blocker overdose, glucagon is considered as a useful treatment of choice

– Glucagon treatment may induce vomiting; Premedication with antiemetic

-side effects of glucagon include hypocalcemia and hyperglycemia

–calcium salts may provide benefits for hypotensive patients or in combination with a calcium channel blocker

-Cases refractory to fluids, atropine, and glucagon; should be considered candidates for high-dose insulin, euglycemia treatment. High-dose insulin, euglycemia to augment cardiac contractility. High-dose insulin, euglycemia can cause profound hypokalemia and hypoglycemia

-Due to intrinsic lipophilicity, certain beta-blockers may cause CNS depression

-lipid-soluble beta-blockers are more toxic than the water-soluble agents because of their quinidine-like effects (class 1a antiarrhythmic)

-Premedication with atropine during intubation may be necessary-Toxicity secondary to water-soluble and renally excreted beta-blockers (e.g., acebutolol, atenolol, nadolol, and sotalol) may respond to multiple doses activated charcoal, hemoperfusion or hemodialysis

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