A comparison of vasopressin and glucagon in beta-blocker induced toxicity.
OBJECTIVE
We compared the efficacy of vasopressin and glucagon in a porcine model of beta-blocker toxicity. Our primary outcome was survival over 4 hours.


METHODS
Sixteen pigs received a 1-mg/ kg bolus of propranolol IV followed by continuous infusion at 0.25 mg/kg/minute. Toxicity was defined as a 25% decrease in the product of heart rate (HR) and mean arterial pressure (MAP), at which point 20 mL/kg normal saline was rapidly infused. Each pig was randomly assigned to receive either vasopressin or glucagon after the saline bolus. The vasopressin group received a continuous infusion at 0.0028 U/kg/minute, titrated up to a maximum of 0.014 U/ kg/minute. The glucagon group received a 0.05-mg/kg bolus followed by continuous infusion at 0.15 mg/kg/hour. The HR, MAP, systolic BP (SBP), cardiac output (CO), glucose, and pH were monitored for 4 hours from toxicity or until death.


RESULTS
One pig survived at 4 hours (vasopressin group). Analysis of the 4-hour Kaplan-Meier survival curves found no differences between the groups (log-rank test 0.059, p = 0.81). No overall differences were identified in MAP, systolic BP, cardiac output, glucose, pH, or HR. However, over the first hour MAP and SBP were significantly higher in the vasopressin group (p = 0.004, p = 0.006, respectively).


CONCLUSIONS
In this beta-blocker toxicity model, there were no differences in the survival curves between vasopressin- and glucagon-treated pigs during a 4-hour analysis period. No overall differences were noted in MAP, systolic BP, CO, HR, pH, or glucose levels, although vasopressin treatment yielded higher MAP and systolic BP early in resuscitation.
Department of Emergency Medicine, Regions Hospital, St. Paul, Minnesota 55101, USA. Joel.S.Holger@HealthPartners.com
Joel S
JS
Holger
Kristin M
KM
Engebretsen
Christopher L
CL
Obetz
Tanya L
TL
Kleven
Carson R
CR
Harris
D000319:Adrenergic beta-Antagonists / Q000506:poisoning*; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D004195:Disease Models, Animal; D005934:Glucagon / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D011041:Poisoning / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D011433:Propranolol / Q000506:poisoning*; D015996:Survival Rate; D013552:Swine; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D005934:Glucagon; D011433:Propranolol