title: Methylene blue reverses recalcitrant shock in β-blocker and calcium channel blocker overdose.
abstract: β-blocker and calcium channel blocker toxicity generally present with bradycardia and hypotension. A 69-year-old woman presented after a suicide attempt with a β-blocker and calcium channel blocker overdose. Her blood pressure was 69/35 mm Hg and her HR was in the 40s. She was treated with calcium chloride, glucagon, a dextrose-insulin infusion and three vasopressors, but remained hypotensive. She suffered two cardiac arrests and required a transvenous pacemaker. When all interventions failed, she was started on a methylene blue infusion for refractory vasodilatory shock which resulted in a dramatic improvement in her blood pressure. The patient was successfully weaned off all vasopressors and from mechanical ventilation without any end-organ damage.
authors: Department of Medicine Division of Pulmonary & Critical Care Medicine,  Maimonides Medical Center, Brooklyn, New York,  USA.
authors: Nidhi
authors: N
authors: Aggarwal
authors: Yizhak
authors: Y
authors: Kupfer
authors: Chanaka
authors: C
authors: Seneviratne
authors: Sidney
authors: S
authors: Tessler
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000368:Aged; D002121:Calcium Channel Blockers / Q000009:adverse effects*; D062787:Drug Overdose / Q000150:complications* / Q000188:drug therapy; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008751:Methylene Blue / Q000627:therapeutic use*; D012769:Shock / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D004791:Enzyme Inhibitors; D008751:Methylene Blue