Clinical presentation

Effects of beta-blocker poisoning include:

• cardiovascular effects
  • hypotension due to a combination of myocardial depression and bradycardia
  • sinus bradycardia (most common arrhythmia)
  • first- to third-degree heart block, junctional bradycardia; ventricular bradycardia and asystole in severe poisoning
  • QRS widening in propranolol poisoning
  • QT-interval prolongation in sotalol poisoning
• central nervous system effects—seizures, delirium and coma if poisoning is due to a lipophilic beta blocker (eg propranolol)
• respiratory effects—bronchospasm and pulmonary oedema, especially in patients with airway disease
• metabolic effects—hypoglycaemia (uncommon) or hyperglycaemia.