Glucagon treatment for symptomatic beta blocker overdose

Incidents of beta blocker overdose and beta blocker toxicity are associated with significant morbidity and mortality (Sheppard, 2006). Prehospital care providers are likely to have experience and knowledge of managing patients who present following accidental and intentional drug overdose.

However, the incidence of beta blocker overdose is less frequent than other commonly prescribed medications in the UK (Health Protection Agency, 2010); and due to a broad range of presenting symptoms from asymptomatic through to life-threatening cardiogenic shock, managing patients following beta blocker overdose is likely to be both clinically challenging and complex (Page et al, 2009).

This case report examines an intentional overdose of propranolol, and its subsequent treatment with intravenous glucagon. The pharmacology of beta blockers and toxicity in overdose will be examined, as will management of this condition, including glucagon treatment.

Finally, as UK paramedics are familiar with administering intramuscular glucagon for the treatment of hypoglycaemia have this drug available to them, and possess the necessary skills for obtaining intravenous access (Joint Royal Colleges Liaison Committee (JRCALC), 2006); could intravenous glucagon be considered appropriate for administration by UK paramedics in cases of symptomatic beta blocker overdose?