Massive Metoprolol Poisoning Treated with Prenalterol

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Abstract
A case of massive metoprolol poisoning (50 g) is described. Clinical signs included coma, seizures, hypoventilation, unmeasurable blood pressure, nodal bradycardia, and metabolic acidosis. Treatment comprised intubation, assisted ventilation, gastric lavage, atropine, bicarbonate, glucagon and repeated doses of prenalterol (a total of 160 mg over 15 hours). Prenalterol dosage was simple and could be guided by blood pressure response. Pacemaker treatment was not required. Ethanol concentration was 50 mmol/l (2.4%) on admission. Plasma metoprolol was 68 mumol/l (18 000 ng/ml) 2 hours after admission. The patient was awake after 15 hours.