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Glucagon for the treatment of symptomatic β blocker overdose
  1. R Boyd, Consultant,
  2. A Ghosh, Senior Clinical Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether the intravenous glucagon can support blood pressure in β blocker overdose. A total of 51 papers were found using the reported search, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by R Boyd,ConsultantChecked by A Ghosh, Senior Clinical Fellow

    Clinical scenario

    A 25 year old patient presents to the emergency department two hours after taking a significant overdose of propanolol. She is bradycardic and hypotensive despite initial resuscitation with oxygen and intravenous fluids. An ECG shows a sinus bradycardia of 50 bpm. You have heard of treatment with intravenous glucagon but wonder if it has been of any proved benefit.

    Three part question

    In [symptomatic significant beta-blocker overdose] is [intravenous glucagon] effective at [reversing the induced hypotension]?

    Search strategy

    Medline 1966–02/03 using the OVID interface. [exp glucagon Or glucagon.mp] AND [{exp adrenergic beta antagonist} AND {exp poisoning OR exp overdose OR poisoning.mp OR intoxication.mp overdose.mp} OR {beta blocker overdose.mp OR beta blocker poisoning.mp}]

    Search outcome

    Altogether 51 papers were found of which six were deemed relevant. No clinical trials were identified and all the papers available were case reports. Details of these papers are shown in table 4.

    Table 4

    Comment(s)

    No clinical trials or even case controlled studies have been published. There is therefore only anecdotal evidence for the use of glucagon. The doses of glucagon suggested are higher than the usual therapeutic doses given in hypoglycaemia and this is expensive. No reports of failure to respond to glucagon are found in the literature. This is most probably attributable to reporting and publication bias. Further research is required.

    Clinical bottom line

    There is not enough evidence currently available to support the use of glucagon in β blocker overdose.

    Report by R Boyd,ConsultantChecked by A Ghosh, Senior Clinical Fellow

    References

    View Abstract

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