see also: [[high dose insulin euglycemia therapy]], [[beta blocker overdose]] # Toxic Mechanism - beta blocker and K+ blocker effects - [[Long QT|prolonged QT]] - [[Torsades de Pointes]] - unlike propranolol, it does not breach the blood brain barrier so no direct CNS effects (but can be ALOC from shock / low cardiac output) # Treatment - QT prolongation: Correct QT-dependent electrolytes (potassium, calcium, magnesium) to the upper limit of normal - catacholamines - consider [[high dose insulin euglycemia therapy|HIET]] for hypotension - overdriving pacing for [[Torsades de Pointes]] at 80-90 BPM - no evidence for ppx Mg2+ if normal level **Bradycardia and long QT** - risk for Torsades (==R on T==) - Mg2+ - speed them up Can use Adrenaline or isoprenaline > isoprenaline causes hypotension and then they need noradrenaline as well) If losing output and arrest --> ACS algorithm ==but withhold amiodarone== > Consider [[ECMO]] ## controversies - **glucagon** - emittogenic - need a lot - not very effective # Disposition If asymptomatic with normal ECG at 6 hours, likely discharge or “medically clear” (pending MH review if deliberate OD)