Maintenance dosing ranged from 1 to 10 units/kg/h of insulin. Two case reports showed clear haemodynamic improvement in a timeframe consistent with insulin administration (bolus then continuous infusion). High-dose insulin euglycaemic therapy: The use of this therapy was associated with mortality benefit in 10 case series. These agents most likely provided a survival benefit and improved haemodynamics.Ītropine: Multiple intravenous boluses of atropine were associated with improvement in heart rate and blood pressure in one case report.Ĭalcium: Intravenous calcium was associated with an improvement in haemodynamics in three out of six case reports but in association with multiple other therapies as well as in two animal studies. As there was concurrent utilisation of multiple interventions, it was difficult to draw definitive conclusions regarding the relative contribution of these interventions to mortality or survival.Ĭatecholamines, inotropes and vasopressors: The use of catecholamines in treating beta-blocker toxicity was reported in 16 case reports, 3 case series and 2 animal studies. Gastric decontamination: Fifteen case reports described the administration of activated charcoal and five detailed the use of gastric lavage. Results: The risk of bias was high for all interventions.

Primary outcomes included mortality and improvement in haemodynamic parameters (e.g., heart rate, blood pressure or a composite measure able to quantitate a haemodynamic response). Two reviewers screened titles and abstracts prior to selecting 141 articles (Kappa on articles included = 0.982, 95% CI 0.980–0.985).

The search strategy identified 15, 553 citations. Methods: Searches were conducted across MEDLINE (1946–26 November 2019, Ovid) Embase (1974–26 November 2019, Ovid) and the Cochrane Central Register of Controlled Trials (CENTRAL, to 26 November 2019) utilising a combination of subject headings and free text. Objective: To evaluate the effects of treatments for beta-adrenoreceptor antagonist poisoning. Introduction: Beta-adrenoreceptor antagonist (beta-blocker) poisoning is a common overdose which can lead to significant morbidity and mortality.

Beta blocker overdose antidote