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Updated: May 10, 2026

Methods for ECG Evaluation of Indicators of Cardiac Risk, and Susceptibility to Aconitine-induced Arrhythmias in Rats Following Status Epilepticus

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Hemodynamically unstable: accidental atenolol toxicity?

Nathan R Hoot¹, John G Benitez, Kenneth H Palm

¹Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

The Journal of Emergency Medicine

|June 4, 2013

Summary

Patients with chronic kidney disease on peritoneal dialysis may experience atenolol toxicity due to poor drug clearance. Glucagon therapy effectively treated a patient with unintentional atenolol accumulation and mesenteric ischemia.

Keywords:

atenolol drug toxicity peritoneal dialysis pharmacokinetics shock

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Area of Science:

Nephrology
Clinical Pharmacology

Background:

Antihypertensive medications, particularly beta-blockers, are common in chronic kidney disease (CKD).
Atenolol's renal excretion and poor clearance by peritoneal dialysis (PD) can lead to accumulation.
This accumulation may predispose patients to toxicity over time.

Observation:

A patient with end-stage renal disease (ESRD) on PD presented with hypotension, bradycardia, and abdominal pain.
The patient reported no recent changes or overdose of her antihypertensive medications, including atenolol.
The clinical presentation was attributed to unintentional atenolol toxicity.

Findings:

Atenolol toxicity was diagnosed in a patient with ESRD undergoing PD.
The patient experienced hemodynamic instability and mesenteric ischemia secondary to the toxicity.
Glucagon therapy rapidly resolved the hemodynamic instability and pain.

Implications:

Unique pharmacokinetics of medications must be considered in patients with impaired renal clearance.
Gradual accumulation of drugs like atenolol can lead to significant toxicity in CKD patients on PD.
This case highlights the importance of monitoring drug levels and considering alternative antihypertensives in this population.