Successful treatment of severe atenolol overdose with calcium chloride

Abstract

Atenolol, a selective β 1 -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. RÉSUMÉ L'aténolol, un inhibiteur des récepteurs β 1 -adrénergiques, est utilisé couramment pour traiter l'hypertension, l'insuffisance coronarienne et les dysrythmies cardiaques. La littérature fait état de peu de cas d'intoxication à l'aténolol et un seul de ces rapports discutait du recours au chlorure de calcium comme forme de traitement. Nous présentons un cas d'intoxication à l'aténolol accompagnée d'un état de choc et d'un bloc cardiaque du premier degré pour lequel l'administration de chlorure de calcium eut des résultats remarquables après l'échec du traitement conventionnel. De plus, nous présentons la pharmacocinétique, la toxicologie et la prise en charge de l'intoxication aux β-bloquants, notre propos étant axé sur le rôle possible du chlorure de calcium.

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“…Pertinently, doses of up to 1200 mg/day of atenolol have been reported to be well-tolerated without clinical manifestations. [12]…”

Part 8: Advanced Life Support

“…539,540 A single human case report documented that high-dose insulin (10 U/kg/h IV), given with glucose supplementation and electrolyte monitoring, was followed by improved hemodynamic stability and survival to hospital discharge in the setting of severe cardiovascular toxicity associated with ␤-blocker toxicity (LOE 5). 541 Case reports described the use of phosphodiesterase inhibitors (LOE 5), 542,543 calcium salts (LOE 4), 544 extracorporeal support (LOE 5), 545 intraaortic balloon pumps (LOE 4), 546 and ECMO (LOE 4). 547 Animal studies supported the use of calcium salts (LOE 5) 548 and the phosphodiesterase inhibitor amrinone (LOE 5).…”

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

“…When taken in overdose, β-blocker intoxication presents a formidable therapeutic challenge. Current recommendations for the treatment of β-blocker poisoning advocate infusion of catecholamines [12], calcium chloride [13], glucagon [14,15] and extracorporeal life support [16] in instances of refractory cardiovascular collapse. More recently, high-dose insulin-glucose euglycaemia [17,18] and Levosimendan [19] have been demonstrated effective in animal models and clinical cases of β-blocker toxicity.…”