We report a case of metoprolol and nifedipine overdose complicated by hypotension which responded to intravenous boluses of calcium chloride and glucagon. The blood pressure was subsequently stabilised by continuous glucagon infusion with the aid of an insulin-dextrose drip. The discussion is focused on the role of antidotes and catecholamine inotropes in the management of beta-blocker and calcium channel blocker poisoning.
LoveJ.N., HowellJ.M., LitovitzT.L., Klein-SchwartzW.Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity.J Toxicol Clin Toxicol2000; 38(3): 275–81.
2.
RamoskaE.A., SpillerH.A., WinterM., BorysD.A one-year evaluation of calcium channel blocker overdoses: toxicity and treatment.Ann Emerg Med1993; 22(2): 196–200.
LenzK., DrumlW., KleinbergerG., LaggnerA., SchneeweissB.Acute intoxication with prazosin: case report.Hum Toxicol1985; 4(1): 53–6.
5.
PertoldiF., D'OrlandoL., MercanteW.P.Electromechanical dissociation 48 hours after atenolol overdose: usefulness of calcium chloride.Ann Emerg Med1998; 31(6): 777–81.
6.
BuckleyN., DawsonA.H., HowarthD., WhyteI.M.Slow-release verapamil poisoning. Use of polyethylene glycol whole-bowel lavage and high-dose calcium.Med J Aust1993; 158(3): 202–4.
7.
LeveyG.S., FletcherM.A., KleinI., RuizE., SchenkA.Characterization of 125I-glucagon binding in a solubilized preparation of cat myocardial adenylate cyclase. Further evidence for a dissociable receptor site.J Biol Chem1974; 249(9): 2665–73.
8.
YagamiT.Differential coupling of glucagon and beta-adrenergic receptors with the small and large forms of the stimulatory G protein.Mol Pharmacol1995; 48(5): 849–54.
9.
MeryP.F., BrechlerV., PavoineC., PeckerF., FischmeisterR.Glucagon stimulates the cardiac Ca2+ current by activation of adenylyl cyclase and inhibition of phosphodiesterase.Nature1990; 345(6271): 158–61.
BenoitB.Glucagon in β-blocker and calcium channel blocker overdoses: a systematic review.J Toxicol Clin Toxicol2003; 41(5): 595–602.
13.
WalterF.G., FryeG., MullenJ.T., EkinsB.R., KhasigianP.A.Amelioration of nifedipine poisoning associated with glucagon therapy.Ann Emerg Med1993; 22(7): 1234–7.
14.
PapadopoulosJ., O'NeilM.G.Utilization of a glucagon infusion in the management of a massive nifedipine overdose.J Emerg Med2000; 18(4): 453–5.
15.
AguraE.D., WexlerL.F., WitzuburgR.A.Massive propanolol overdose. Successful treatment with high-dose isoproterenol and glucagon.Am J Med1986; 80(4): 755–7.
16.
YuanT.H., KernsW.P.2nd, TomaszewskiC.A., FordM.D., KlineJ.A.Insulin-glucose as adjunctive therapy for severe calcium channel antagonist poisoning.J Toxicol Clin Toxicol1999; 37(4): 463–74.
17.
LoveJ.N., SachdevaD.K., BessmanE.S., CurtisL.A., HowellJ.M.A potential role for glucagon in the treatment of drug-induced symptomatic bradycardia.Chest1998; 114(1): 323–6.
MegarbaneB., KaryoS., BaudF.J.The role of insulin and glucose (hyperinsulinaemia/euglycaemia) therapy in acute calcium channel antagonist and beta-blocker poisoning.Toxicol Rev2004; 23(4): 215–22.
20.
TabouletP., CariouA., BerdeauxA., BismuthC.Pathophysiology and management of self-poisoning with beta-blockers.J Toxicol Clin Toxicol1993; 31(4): 531–51.
