Treatment for hypotension

Commence continuous ECG monitoring and assess serial 12-lead ECGs in all except minor beta-blocker poisonings.

For hypotension due to beta-blocker poisoning, first-line treatment is intravenous fluid resuscitation.

For bradycardia associated with hypotension, treat additionally with atropine. Use:

atropine 0.6 mg (child: 0.02 mg/kg up to 0.6 mg) intravenously; repeat once after 15 minutes if required for bradycardia. beta-blocker poisoning - bradycardia atropine

If hypotension persists, start inotropic support with adrenaline (epinephrine).

The inotrope recommendations below (adrenaline, and high-dose insulin euglycaemia therapy [HIET]) are based on animal studies and anecdotal experience. Bedside echocardiography is useful to determine the relative contributions of negative inotropy and vasodilation to hypotension, and hence guides treatment choice. Discuss further management with a clinical toxicologist.