Review Article

Toxic Bradycardias in the Critically Ill Poisoned Patient

Table 2

Literature on vasopressor use in toxic bradycardia.

StudySummary

Kerns, W., 2nd, et al., Insulin improves survival in a canine model of acute beta-blocker toxicity. Annals of Emergency Medicine, 1997. 29(6): p. 748–57.Survival better for animals treated with insulin compared to those treated with glucagon or epinephrine.

Toet, A.E., et al., Reduced survival after isoprenaline/dopamine in d,l-propranolol intoxicated rats. Human and Experimental Toxicology, 1996. 15(2):120–8.No improvement in hemodynamic variables with isoproterenol. Addition of dopamine resulted in decreased MAP and survival time.

Toet, A.E., et al., Experimental study of the detrimental effect of dopamine/glucagon combination in d,l-propranolol intoxication. Human and Experimental Toxicology, 1996. 15(5): 411–21.No improvement of survival time with dopamine/glucagon but some improvement in hemodynamic variables.

Holger, J.S., et al., A comparison of vasopressin and glucagon in beta-blocker induced toxicity. Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists, 2006. 44(1): 45–51.Vasopressin resulted in higher MAP/SBP but no difference in survival compared to glucagon in porcine model.

Holger, J.S., et al., Insulin versus vasopressin and epinephrine to treat beta-blocker toxicity. Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists, 2007. 45(4): 396–401.Increased SVR with vasopressin/epinephrine but decreased survival when compared to insulin in porcine model.

Kanagarajan, K., et al., The use of vasopressin in the setting of recalcitrant hypotension due to calcium channel blocker overdose. Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists, 2007. 45(1): p. 56–9.Successful use of vasopressin in patient refractory to other therapies.

Kline, J.A., E. Leonova, and R.M. Raymond, Beneficial myocardial metabolic effects of insulin during verapamil toxicity in the anesthetized canine. Critical Care Medicine, 1995. 23(7): p. 1251–63.Insulin resulted in improved hemodynamic variables compared to epinephrine, calcium chloride, or glucagon.

Stone, C.K., et al., Glucagon and phenylephrine combination versus glucagon alone in experimental verapamil overdose. [see comment]. Academic Emergency Medicine, 1996. 3(2): p. 120–5.Decreased survival when phenylephrine combined with glucagon.

Barry, J.D., et al., Vasopressin treatment of verapamil toxicity in the porcine model. J Med Toxicol, 2005. 1(1): p. 3–10.Decreased survival with vasopressin.

Sztajnkrycer, M.D., et al., Use of vasopressin in a canine model of severe verapamil poisoning: a preliminary descriptive study. Academic Emergency Medicine, 2004. 11(12): p. 1253–61.Decreased cardiac index and no improvement in MAP.

Anderson FJ, Hart GR, Crumpler CP, Lerman MJ: Clonidine overdose: Report of six cases and review of the literature. Ann Emerg Med 1981; 10 : 107–112.Successful use of dopamine for improved blood pressure.