serum glucose and calcium channel blocker and beta blocker overdose

RAGING HYPOTHETICAL:
--you have a patient that is bradycardic/hypotensive/unresponsive/dead
--you suspect calcium channel blocker or beta blocker overdose
--nurse has done a fingerstick glucose--how does this help you?



BLOOD GLUCOSE (in a non-diabetic=helpful):
--calcium channel blocker OD:  hyperglycemia (BG is high)
--beta blocker OD: hypoglycemia (BG is low)


WHY?
--calcium channel blockers:

• hyperglycemia caused by inhibition of calcium-mediated insulin release 

--beta blockers:

• epinephrine, acting via the beta-adrenergic receptors, has important effects on glucose metabolism
• increases glucose production by stimulating both glycogenolysis and gluconeogenesis
• increases the delivery of these gluconeogenic substrates from the periphery
• inhibits glucose utilization by several tissues
• via the alpha-2-receptors, inhibits insulin secretion
• BLOCK all these, glucose gets low

TREATMENT OPTIONS:
--ABCs, IVF
--calcium
--glucagon
--high dose insulin/glucose
--pressors
--lipid emulsion


10-SECOND TAKEAWAY:
--calcium channel blocker OD: glucose is high
--beta blocker OD: glucose is low
--treatment toolbox: calcium, glucagon, insulin/glucose, pressors, lipid emulsion


Reference(s): uptodate.com: calcium channel blocker poisoning, beta blocker poisoning, major side effects of beta blockers, picture