Massive metoprolol poisoning treated with prenalterol

Area of Science:

• Cardiology
• Clinical Toxicology

Background:

• Massive metoprolol overdose presents a significant clinical challenge due to its cardiotoxic effects.
• Beta-blocker poisoning can lead to severe bradycardia, hypotension, seizures, and metabolic disturbances.

Observation:

• A patient presented with coma, seizures, hypoventilation, unmeasurable blood pressure, nodal bradycardia, and metabolic acidosis following ingestion of 50g of metoprolol.
• Initial ethanol concentration was 50 mmol/l, and plasma metoprolol levels reached 68 µmol/l two hours post-admission.

Findings:

• Treatment involved intubation, assisted ventilation, gastric lavage, atropine, bicarbonate, glucagon, and repeated doses of prenalterol (160 mg over 15 hours).
• Prenalterol administration was straightforward and guided by blood pressure response.
• The patient regained consciousness within 15 hours, and pacemaker treatment was avoided.

Implications:

• This case highlights the efficacy of prenalterol as a treatment for massive metoprolol poisoning.
• Early and aggressive management, including the use of specific antidotes like prenalterol, can prevent the need for invasive procedures such as pacemaker insertion.
• Understanding the management of severe beta-blocker toxicity is crucial for emergency medicine and toxicology specialists.