Decontamination

For severe beta-blocker poisoning, consider gastrointestinal decontamination with activated charcoal as soon as the patient has been resuscitated. If the patient is intubated, give activated charcoal via a nasogastric or orogastric tube as soon as possible—confirm correct placement of the nasogastric or orogastric tube beforehand.

Otherwise, offer activated charcoal to alert and cooperative patients who are able to protect their airway and present within:

• 2 hours after ingesting an immediate-release preparation
• 4 hours after ingesting a modified-release preparation of metoprolol.