![]() The mechanism is complex but one way to simply it is thinking about it as a "lipid sink." Free plasma medications are ‘caught’ by lipid intravascularly, effectively lowering their plasma concentration. It can also be used for any lipophilic medication in case of overdose. Intralipid's major use is for reversal of high dose local anesthetic overdose. It is best to give a single bolus (specifically calcium gluconate, unless central access is available) to assess efficacy, then start a drip if effective.ĭose: 0.6 mL/kg of 10% Ca Gluc then start 0.6-1.5 mL/kg/hr Ca Gluc High Dose Insulin/EuglycemiaĬurrently the only FDA indication is for fat emulsion in TPN. There are few case studies to suggest mild elevation in HR, but no increase in cardiac inotropy or blood pressure. ![]() Given that the downstream effect of BBs is to decrease intracellular calcium, it is reasonable to give empiric calcium IV. However, there is no significant literature to support its efficacy and hypercalcemia has been shown to inhibit the action of glucagon in animal models. Dopamine – Can increase inotropy/chronotropy but paradoxically decreases SVR and worsens hypotension.Isoproterenol – Seems logical given pure beta stimulation but does not seem to be effective from multiple case reports. Combine with norepinephrine to add peripheral vasoconstriction support.Norepinephrine/Epinephrine – Best choice with anecdotal evidence and case reports, titrate directly to effect.CatecholaminesĪt this point there is no clear winner for which pressor is best, but regardless you will need MUCH higher doses than you are used to giving. Symptomatic bradycardia requires immediate intervention. Transcutaneous pacing is frequently attempted but rarely effective. Due to decreased intracellular calcium, the voltage needed for pacing capture is much higher than typical. Aim for a rate 50-60 to allow increased repolarization time for intracellular calcium to accumulate. Severe nausea and vomiting – always give antiemetic with first dose to prevent potential airway emergencyĪtropine may be effective and there is no downside in trying. If effective, it will need frequent re-dosing or a drip given its short half life.ĭose: 0.5-1 mg in adults, 0.2 mg/kg in children Transcutaneous/Transvenous Pacing.It is reasonable to give 2 doses and, if efficacious, start drip at the effective dose – for example, if two 5 mg doses increased HR, then start a glucagon drip at 10 mg/hr. There is no defined therapeutic ceiling at this time. Re-bolus as needed every 10 minutes given short half life (~20 min).Initial dose: 5-10 mg IV and assess for efficacy.It also increases hepatic gluconeogenesis, counteracting the hypoglycemia caused by B2 blockade. This is the gold standard at this time, and is the “board answer” to treat beta blocker toxicities. Glucagon acts by directly increasing cardiac inotropy by activating adenyl cyclase by a secondary mechanism separate from that of catecholamines, bypassing beta blockade.metoprolol succinate) formulations even after the first few hours have elapsedĭO NOT delay airway or pharmacologic support to perform GI decontamination This consists of both gastric lavage, charcoal administration, +/- total bowel irrigationĬonsider these interventions in certain extended release (i.e. Requirements are secure airway (either mental status or with an endotracheal tube) plus + compliant patient ![]() This is only indicated during first 1-2 hours of potentially fatal overdose
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