ABC: časopis urgentne medicine (Jan 2016)
Beta adrenergic blockers poisoning
Abstract
AIM: To demonstrate the basic characteristics in terms of clinical features and a basic method of treatment in β-adrenergic blockers poisoning. MATERIALS AND METHODS: Review of the available literature, the protocols of departments that participated in the diagnosis and treatment of these patients in the Health Centre and the General Hospital in Loznica. RESULTS: The clinical features of acute β-blockers poisoning in addition to the dominant cardiovascular effects (arterial hypotension, bradycardia, heart rhythm disorders in the form of AV block of various degrees) toxic effects in the central nervous system exhibit (in case of poisoning by lipophilic β-blockers, i.e. Propranolol) such as: consciousness disorders up to the level of coma, convulsions, muscle weakness, mood disorders. There are also a variety of metabolic changes such as hypoglycemia which occurs by blocking the process of gluconeogenesis, and occurs several hours after ingestion of drugs. Bronchospasm is not so common. It occurs more frequently in patients with COPD. Changes in the gastrointestinal and urinary tract are less common. Clinical picture of acute poisoning with these drugs develops usually 1-3 hours after ingestion. The earliest symptoms of acute poisoning are weakness, dizziness and mental status changes. Treatment of acute poisoning β-blockers is based on knowledge of basic pharmacodynamic mechanisms and pathophysiology of overdose and poisoning. Method of treatment depends on the progression of clinical manifestations. Initial treatment of forms of mild poisoning includes gastrointestinal decontamination and application of active coal (charcoal). In severe forms of poisoning, necessary measures includes cardiopulmonary resuscitation, artificial ventilation, application of antidotes and correction of severe metabolic and electrolyte disorders. In addition to numerous non- pharmacological and specific pharmacological measures, specific therapy for beta adrenergic blockers poisoning is supportive. CONCLUSION: Due to the wide range of use, in spite of development of safe β-blockers, intoxications by these drugs are in increase. In children, the most often is accidental poisoning, while in adults the most frequent is intentional overdose. Poisoning is somewhat more common in women. In spite of a modern therapeutic approach, these poisonings are characterized by severe clinical features and relatively high mortality, so it is necessary to identify first then to treat adequately any toxicity of these drugs.
