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Successful treatment of severe atenolol overdose with calcium chloride

Published online by Cambridge University Press:  21 May 2015

John O’Grady
Affiliation:
Department of Emergency Medicine, University of Western Ontario, London Health Sciences Centre, London, Ont
Scott Anderson*
Affiliation:
Department of Emergency Medicine, University of Western Ontario, London Health Sciences Centre, London, Ont
Derrick Pringle
Affiliation:
Department of Emergency Medicine, University of Western Ontario, London Health Sciences Centre, London, Ont
*
EMA Office, London Health Sciences Centre, 375 South St., London ON N6A 4G5; fax 519 667-6769, sanderso@julian.uwo.ca

Abstract

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Atenolol, a selective β1-adrenergic antagonist, is commonly used to treat hypertension, ischemic heart disease and cardiac dysrhythmias. Few cases of severe atenolol intoxication have been described, and only one of these reports discussed the use of calcium chloride as a treatment. We present a case of atenolol overdose associated with shock and first-degree heart block, in which administration of calcium chloride led to dramatic improvement after failure of conventional treatment. In addition, we discuss the pharmacokinetics, toxicology and management of β-blocker overdose, focusing on the possible role of calcium chloride.

Type
Case Report • Observations
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

References

1.Hoffman, BB, Lefkowitz, RJ.Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists. In: Goodman, LS, Gilman, A, Hardman, JG, Limbird, LE.Goodman & Gilman’s the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill; 1996. p. 199248.Google Scholar
2.Wadworth, AN, Murdoch, D, Brogden, RN.Atenolol: a reappraisal of its pharmacological properties and therapeutic use in cardiovascular disorders. Drugs 1991;42:468510.Google Scholar
3.Montgomery, AB, Stager, BSN, Schoene, RB.Marked suppression of ventilation while awake following massive ingestion of atenolol. Chest 1985;88:9201.Google Scholar
4.Weinstein, RS, Cole, S, Knaster, HB, Dalbert, T.Beta blocker overdose with propranolol and with atenolol. Ann Emerg Med 1985; 14:1613.CrossRefGoogle ScholarPubMed
5.Freestone, S, Thomas, HM, Bhamra, RK, Dyson, EH.Severe atenolol poisoning: treatment with prenalterol. Human Toxicol 1986;5:3435.Google ScholarPubMed
6.Abbasi, IA, Sorsby, . Prolonged toxicity from atenolol overdose in an adolescent. Clin Pharm 1986;5:8367.Google Scholar
7.Saitz, R, Williams, BW, Farber, HW.Atenolol-induced cardiovascular collapse treated with hemodialysis. Crit Care Med 1991;19:1168.CrossRefGoogle ScholarPubMed
8.Stinson, J, Walsh, M, Feely, J.Ventricular asystole and overdose with atenolol. BMJ 1992;305:693.CrossRefGoogle ScholarPubMed
9.Delima, LGR, Kharasch, ED, Butler, S.Successful pharmacologic treatment of massive atenolol overdose: sequential hemodynamics and plasma atenolol concentration. Anesthesiology 1995;83:2047.Google Scholar
10.Pertoldi, F, D’Orlando, L, Mercante, WP.Electromechanical dissociation 48 hours after atenolol overdose: usefulness of calcium chloride. Ann Emerg Med 1998;31:77781.CrossRefGoogle ScholarPubMed
11.Boakes, AJ, Boerre, BH.Suicidal attempts with β1-adrenoreceptor blocking agents [letter]. BMJ 1973;4:675.CrossRefGoogle Scholar
12.Shanahan, FLJ, Counihan, TB.Atenolol self-poisoning [letter]. BMJ 1978;2:773.CrossRefGoogle ScholarPubMed
13.Giang, D, Isaeff, DM.Atenolol overdose in a patient with progressive renal failure. West J Med 1986;145:1013.Google Scholar
14.Reith, DM, Dawson, AH, Epid, D, Whyte, IM, Buckley, NA, Sayer, GP.Relative toxicity of beta blockers in overdose. J Toxicol Clin Toxicol 1996;34:2738.CrossRefGoogle ScholarPubMed
15.Brimacombe, JR, Scully, M, Swainston, R.Propranolol overdose: a dramatic response to calcium chloride. Med J Aust 1991;155: 2678.CrossRefGoogle ScholarPubMed
16.Sangster, B, de Wildt, D, van Dijk, A, Klein, S.A case of acebutolol intoxication. J Toxicol Clin Toxicol 1983;20(1):6977.CrossRefGoogle ScholarPubMed
17.Ehgartner, GR, Zelinka, MA.Hemodynamic instability following intentional nadolol overdose. Arch Intern Med 1988;148(4):8012.Google Scholar
18.Love, JN.Beta blocker toxicity after overdose: When do symptoms develop in adults? J Emerg Med 1994;12:799802.Google Scholar
19.Frishman, WH, Jacob, H, Eisenberg, E, Ribner, H.Clinical pharmacology of the new beta-adrenergic blocking drugs. Part 8. Self-poisoning with beta-adrenoreceptor blocking agents: recognition and management. Am Heart J 1979;98(6):798811.CrossRefGoogle Scholar
20.Henry, JA, Cassidy, SL.Membrane stabilizing activity: a major cause of fatal poisoning. Lancet 1986;1(8495):14147.Google Scholar
21.Kerns, W, Ransom, M, Tomaszewski, C, Kline, J, Raymond, R.The effects of extracellular ions on beta-blocker cardiotoxicity. Toxicol Appl Pharmacol 1996;137:17.Google Scholar
22.Langemeijer, JJ, deWildt, DJ, de Groot, G, Sangster, B.Calcium interferes with the cardiodepressive effects of beta blocker overdose in isolated rat hearts. J Toxicol Clin Toxicol 1986;24:11133.CrossRefGoogle ScholarPubMed
23.Amundson, DE, Brodine, SK.A fatal case of propranolol poisoning. Drug Intell Clin Pharm 1988;22:7812.Google Scholar
24.Ganong, WF.Hormonal control of calcium metabolism and the physiology of the bone. In: Review of medical physiology. 18th ed. Stamford (CT): Appleton & Lange Publications; 1997. p. 35971.Google Scholar
25.Love, JN, Hanfling, D, Howell, JM.Hemodynamic effects of calcium chloride in a canine model of acute propranolol intoxication. Ann Emerg Med 1996;28:16.Google Scholar
26.Thomas, SH.Paracetamol (acetaminophen) poisoning. Pharmacol Ther 1993;60:91120.Google Scholar
27.Boehnert, MT, Lovejoy, FH Jr.Value of the QRS duration versus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants. N Engl J Med 1985;313:4749.Google Scholar
28.Chamberlain, DA.Advanced life support. Revised recommendations of the Resuscitation Council (UK). BMJ 1989;299:4468.Google Scholar
29.Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Guidelines for cardiopulmonary and emergency cardiac care, part III: adult advanced cardiac life support. JAMA 1992;268:2199241.Google Scholar