Continuing Professional Development: Glucagon treatment for symptomatic beta blocker overdose

OverviewSymptomatic beta blocker overdose is a relatively uncommon, but potentially life threatening condition (Sheppard, 2006; Health Protection Agency, 2010). Current definitive treatment for these patients involves intravenous glucagon therapy, and as such, glucagon is considered both a first-line treatment and antidote in cases of symptomatic beta blocker overdose (Joint Formulary Committee, 2011; National Poisons Information Service, 2011a; 2011b). This case report examines an intentional overdose of propranolol, including paramedic pre-hospital management, and subsequent in-hospital definitive treatment involving intravenous glucagon therapy. Paramedics have experience and knowledge of administering intramuscular glucagon as part of their formulary, and possess the necessary skills for obtaining intravenous access. Therefore, could intravenous glucagon be considered appropriate for administration by paramedics as a pre-hospital intervention in cases of symptomatic beta blocker overdose?Learning OutcomesAfter completing this module you will be able to:• Have an understanding of the pharmacology of beta blocker medication and develop an understanding of the toxicity of beta blockers in overdose, and have an awareness of potential toxic doses for adults and paediatrics.• Understand how the presenting clinical features in symptomatic beta blocker overdose relate to an extension of their pharmacology and demonstrate knowledge of current pre-hospital management guidelines and treatment options following beta blocker overdose.• Have an awareness of the indications and implications of intravenous glucagon use in symptomatic beta blocker overdose, and the potential role for this intervention in pre-hospital practice.

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