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Successful treatment of severe atenolol overdose with calcium chloride

  • John O’Grady (a1), Scott Anderson (a1) and Derrick Pringle (a1)

Abstract

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.

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Copyright

Corresponding author

EMA Office, London Health Sciences Centre, 375 South St., London ON N6A 4G5; fax 519 667-6769, sanderso@julian.uwo.ca

References

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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.
2.Wadworth, AN, Murdoch, D, Brogden, RN.Atenolol: a reappraisal of its pharmacological properties and therapeutic use in cardiovascular disorders. Drugs 1991;42:468510.
3.Montgomery, AB, Stager, BSN, Schoene, RB.Marked suppression of ventilation while awake following massive ingestion of atenolol. Chest 1985;88:9201.
4.Weinstein, RS, Cole, S, Knaster, HB, Dalbert, T.Beta blocker overdose with propranolol and with atenolol. Ann Emerg Med 1985; 14:1613.
5.Freestone, S, Thomas, HM, Bhamra, RK, Dyson, EH.Severe atenolol poisoning: treatment with prenalterol. Human Toxicol 1986;5:3435.
6.Abbasi, IA, Sorsby, . Prolonged toxicity from atenolol overdose in an adolescent. Clin Pharm 1986;5:8367.
7.Saitz, R, Williams, BW, Farber, HW.Atenolol-induced cardiovascular collapse treated with hemodialysis. Crit Care Med 1991;19:1168.
8.Stinson, J, Walsh, M, Feely, J.Ventricular asystole and overdose with atenolol. BMJ 1992;305:693.
9.Delima, LGR, Kharasch, ED, Butler, S.Successful pharmacologic treatment of massive atenolol overdose: sequential hemodynamics and plasma atenolol concentration. Anesthesiology 1995;83:2047.
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.
11.Boakes, AJ, Boerre, BH.Suicidal attempts with β1-adrenoreceptor blocking agents [letter]. BMJ 1973;4:675.
12.Shanahan, FLJ, Counihan, TB.Atenolol self-poisoning [letter]. BMJ 1978;2:773.
13.Giang, D, Isaeff, DM.Atenolol overdose in a patient with progressive renal failure. West J Med 1986;145:1013.
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.
15.Brimacombe, JR, Scully, M, Swainston, R.Propranolol overdose: a dramatic response to calcium chloride. Med J Aust 1991;155: 2678.
16.Sangster, B, de Wildt, D, van Dijk, A, Klein, S.A case of acebutolol intoxication. J Toxicol Clin Toxicol 1983;20(1):6977.
17.Ehgartner, GR, Zelinka, MA.Hemodynamic instability following intentional nadolol overdose. Arch Intern Med 1988;148(4):8012.
18.Love, JN.Beta blocker toxicity after overdose: When do symptoms develop in adults? J Emerg Med 1994;12:799802.
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.
20.Henry, JA, Cassidy, SL.Membrane stabilizing activity: a major cause of fatal poisoning. Lancet 1986;1(8495):14147.
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.
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.
23.Amundson, DE, Brodine, SK.A fatal case of propranolol poisoning. Drug Intell Clin Pharm 1988;22:7812.
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.
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.
26.Thomas, SH.Paracetamol (acetaminophen) poisoning. Pharmacol Ther 1993;60:91120.
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.
28.Chamberlain, DA.Advanced life support. Revised recommendations of the Resuscitation Council (UK). BMJ 1989;299:4468.
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.

Keywords

Successful treatment of severe atenolol overdose with calcium chloride

  • John O’Grady (a1), Scott Anderson (a1) and Derrick Pringle (a1)

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