ABSTRACT
Although rare, acute poisoning with beta-blockers can be serious. Including the four personal cases of the authors, 40 cases of propranolol overdose have been published, with 8 deaths. Hypoglycaemia was not reported, but the association with alcohol can be very serious. One case of bronchospasm and one case of acute pulmonary oedema have been reported. Bradycardia is not the rule and widening of the QRS complex was reported in 4 cases. The other cases published are: 1) 10 cases with oxprenolol (including 5 cases of coma and 4 deaths), 2) 9 cases with acebutolol (2 deaths) including 5 with studies of the kinetics of the product (1 personal case), 3) 7 cases with pindolol (no bradycardia, good prognosis), 4) 6 cases (1 personal) with metoprolol (4 cases of massive ingestion with 1 death), 5) 3 cases with alprenolol (1 death), 6) 4 cases with sotalol (2 cases of turned apex, 1 death), 7) 1 case with atenolol. The authors discuss the practical management. They stress that glucagon is a much better form of treatment in severe cases than isopropylnoradrenaline, and that the crucial period is in the first few hours after the ingestion of the beta-blockers, i.e. usually before the patient's arrival at the hospital. The effectiveness of endocavity stimulation has not been demonstrated.
