If they are asymptomatic after this time they can be medically cleared.Įxceptions to the 6-hour rule include patients with sustained-release ingestions and sotalol ingestions, who must be admitted for a 24-hour observation period as toxicity may be delayed.ĭihydropyridines may cause hypotension with reflex tachycardia. Patients with BB ingestion who have significantly overdosed will become symptomatic within 6 hours of the ingestion. blood pH, serum lactate level or mixed venous oxygen saturation).Ĭo-ingestions are the single most important factor associated with morbidity in BB ingestions. The use of alternative markers for perfusion is preferred (i.e. At overdoses, calcium channel selectivity may be lost, which will result in hypotension and bradycardia.Īs with sepsis, vital signs can be misleading during the evaluation of a patient with BB or CCB toxicity. those ending with “-pine”) at therapeutic doses more avidly block smooth muscle calcium channels and may cause hypotension with reflex tachycardia. Mental status generally remains clear until brain becomes significantly hypoperfused.Ĭlass of CCB may alter the clinical presentation: phenylalkylamine and benzothiazepine classes (verapamil and diltiazem, respectively) will bind both myocardial and smooth muscle calcium channels, while dihydropyridine class drugs (i.e. Pulmonary edema, peripheral edema and elevated JVD may result from decreased contractility and vasodilatation (i.e., CHF-like presentation). Hypoglycemia (most often observed in children). QT prolongation (observed with sotalol and acebutolol). QRS prolongation (AKA membrane stabilizing activity ). Seizures (most commonly observed with propranolol). blood pH, serum lactate level or mixed venous oxygen saturation). Treatment is similar for both types of overdoses and should be aggressive.Īs with sepsis, vital signs can be misleading during the evaluation of a patient with BB or CCB toxicity. Description of the problem What every clinician needs to knowīeta blocker (BB) and calcium channel blocker (CCB) overdoses are associated with significant morbidity and mortality.
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