β 受體阻斷劑 (β-blockers) 為常見之高血壓、心臟疾病治療藥物，臨床偶有不當過量使用，甚至中毒案例發生。當疑似beta-blockers 中毒案例發生時，診斷主要基於用藥史和臨床表現，例如心搏過緩和低血壓，嚴重可能心因性休克。處置方式首先評估病人的氣管、呼吸和循環。
低血壓給予靜脈注射輸液治療；有症狀的心搏過緩給予atropine；有症狀的低血糖靜脈注射葡萄糖治療；另外根據嚴重程度給予額外的治療，包括：升糖素、鈣鹽、兒茶酚胺、高劑量胰島素治療、脂肪乳劑治療。本案例報告為一位過量服用propranolol導致心因性休克的病人，並運用文獻回顧探討beta-blockers 中毒之處理方式。
Beta-blockers are common medicines for treating hypertension and heart disease. Occasionally, there are cases of inappropriate overdose and even poisoning in clinical practice. When a suspected poisoning case occurred and was considered related to beta-blockers, the diagnosis was mainly based on medical history and clinical presentation. Bradycardia and hypotension are the most common effects, and overdose can result in cardiogenic shock.
Firstly, the method of management is an assessment of the patient’s airway, breathing, and circulation, treating hypotension with intravenous fluids; using atropine for symptomatic bradycardia; using intravenous dextrose for symptomatic hypoglycemia; furthermore, we can give an additional treatment depending on the severity, including glucagon, calcium salts, catecholamines, high-dose insulin euglycemic therapy, lipid emulsion therapy.
This case report is about an overdose of propranolol causing cardiogenic shock, and we explore the management of beta-blocker poisoning by literature review.
Submitted for publication: 2022.8.9; Accepted for publication: 2022.11.14
