Esmolol overdosage: Difference between revisions
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===Cardiac Failure=== | ===Cardiac Failure=== | ||
Consider intravenous administration of a [[diuretic]] or [[digitalis]] glycoside. In shock resulting from inadequate cardiac contractility, consider intravenous administration of [[dopamine]], [[dobutamine]], [[isoproterenol]], or inamrinone. Glucagon has been reported to be useful. | Consider intravenous administration of a [[diuretic]] or [[digitalis]] glycoside. In shock resulting from inadequate cardiac contractility, consider intravenous administration of [[dopamine]], [[dobutamine]], [[isoproterenol]], or [[inamrinone]]. Glucagon has been reported to be useful. | ||
===Symptomatic hypotension=== | ===Symptomatic hypotension=== | ||
Revision as of 19:45, 20 February 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]
Overdosage
Signs and Symptoms of Overdose
Overdoses of BREVIBLOC (Esmolol Hydrochloride) can cause cardiac and central nervous system effects. These effects may precipitate severe signs, symptoms, sequelae, and complications (for example, severe cardiac and respiratory failure, including shock and coma), and may be fatal. Continuous monitoring of the patient is required.
Cardiac effects include bradycardia,atrioventricular block (1st -, 2nd -, 3rd degree), junctional rhythms, intraventricular conduction delays, decreased cardiac contractility,hypotension, cardiac failure (including cardiogenic shock), cardiac arrest/asystole, and pulseless electrical activity.
Central nervous system effects include respiratory depression,seizures, sleep and mood disturbances, fatigue, lethargy, and coma. In addition, bronchospasm, mesenteric ischemia, peripheral cyanosis, hyperkalemia, and hypoglycemia (especially in children) may occur.
Treatment Recommendations
Because of its approximately 9-minute elimination half-life, the first step in the management of toxicity should be to discontinue the BREVIBLOC infusion. Then, based on the observed clinical effects, consider the following general measures.
Bradycardia
Consider intravenous administration of atropine or another anticholinergic drug or cardiac pacing.
Cardiac Failure
Consider intravenous administration of a diuretic or digitalis glycoside. In shock resulting from inadequate cardiac contractility, consider intravenous administration of dopamine, dobutamine, isoproterenol, or inamrinone. Glucagon has been reported to be useful.
Symptomatic hypotension
Consider intravenous administration of fluids or vasopressor agents such as dopamine or norepinephrine.
Bronchospasm
Consider intravenous administration of a beta 2 stimulating agent or a theophylline derivative.
Dilution Errors
Massive accidental overdoses of BREVIBLOC have resulted from dilution errors. Use of BREVIBLOC PREMIXED Injection and BREVIBLOC DOUBLE STRENGTH PREMIXED Injection may reduce the potential for dilution errors. Some of these overdoses have been fatal while others resulted in permanent disability. Bolus doses in the range of 625 mg to 2.5 g (12.5-50 mg/kg) have been fatal. Patients have recovered completely from overdoses as high as 1.75 g given over one minute or doses of 7.5 g given over one hour for cardiovascular surgery. The patients who survived appear to be those whose circulation could be supported until the effects of BREVIBLOC resolved.[1]
References
Adapted from the FDA Package Insert.