Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity.
OBJECTIVE
To identify factors in exposures to beta blockers (beta-adrenergic receptor antagonists) that are associated with the development of cardiovascular morbidity and contribute to disposition decisions from the emergency department.


METHODS
Prospective cohort of 280 beta blocker exposures reported to 2 regional poison centers. Multiple logistic regression was used to determine association of various clinical factors and outcome.


RESULTS
In this series of beta blocker exposures, 41 (15%) developed cardiovascular morbidity and 4 (1.4%) died. A history of cardioactive coingestant was the only factor significantly associated with the development of cardiovascular morbidity (p < .05). When cases reporting cardioactive coingestants were excluded, a history of ingesting a beta blocker with membrane stabilizing activity was significantly associated with the development of cardiovascular morbidity (p < .05). All those in whom the timing of symptoms could be determined, developed symptoms within 6 hours of ingestion.


CONCLUSIONS
The single most important factor associated with the development of cardiovascular morbidity in beta blocker ingestion is a history of a cardioactive coingestant, primarily calcium channel blockers, cyclic antidepressants, and neuroleptics. In the absence of such coingestion, exposure to a beta blocker with membrane stabilizing activity is associated with an increased risk of cardiovascular morbidity. Beta blocker ingestion is unlikely to result in symptoms if the patient remains asymptomatic for 6 hours after the time of ingestion.
Love
J N
JN
Department of Emergency Medicine, Georgetown University, Washington, DC 20007, USA.
Howell
J M
JM
Litovitz
T L
TL
Klein-Schwartz
W
W
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000401:mortality; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D011039:Poison Control Centers; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000319:Adrenergic beta-Antagonists