Beta-adrenergic antagonist exposures in children

Since limited toxicological data exists for beta-adrenergic antagonist (BA) exposures in children, a survey to describe triage practices by regional poison centers nationwide and to characterize clinical manifestations of unintentional pediatric BA exposures was sent to 49 poison centers. A 7-y retrospective review of acute BA exposures in children aged < 7years from 1 regional poison center was also undertaken. Thirty-three centers (67%) responded: 19/33 (58%) had no established BA triage guideline for young children. The 14/33 remaining centers (42%) most often referred these children to a hospital if any BA was ingested. In the 1-center review, metoprolol (28%) and atenolol (27%) exposures were most common, but = 1 tablet of BA was involved in 83% of the exposures. Symptoms occurred in 8 children; 2/378 had lethargy and 6/378 had bradycardia and/or hypotension. Immediate-release preparations were ingested by 7/8 symptomatic patients (median time to onset of symptoms = 3.0 h, range 45 min to 3.5 h). Of 280 children with definitive follow-up, 272 had no clinical effects, 4 had minor effects, and 4 had moderate effects. Regional poison centers commonly refer children exposed to any amount of BA to the hospital. The majority of BA exposures involved a small amount and significant clinical effects were rare. The range of toxicity for BA in children needs to be established.