Treatment for drug-induced hypotension should be directed at the drug’s action that is causing hypotension. This doesn’t mean administer drugs with opposing actions. For instance, you can’t treat beta blocker OD with beta agonists. The high dose of beta agonist required would cause life-threatening side effects. One way to address it is to circumvent the action causing toxicity, i.e., glucagon circumvents the blocked beta receptor and stimulates the same subcellular protein that is stimulated by the beta receptor.
Do the traditional catecholamine pressors work? Sometimes they do (probably depends on the severity of hypotension). One of the factors is the age of the patient. Young healthy patients have amazing adrenals that respond immediately when hypotension occurs. They also have healthy catecholamine receptors (neither of which may be true in the elderly). But don’t spend a lot of time trying to improve the hypotension with catecholamines. Consider the following treatments for hypotension in the following Overdoses (which will be addressed in subsequent Questions of the Week):
Calcium Channel Blocker-Hyperinsulinemic Euglycemia (HIE)
Sodium Channel Blockers-Sodium Bicarb (serum alkalinization)
Lipophillic Drugs-Itralipid Emulsion (ILE)
The question of the week was prepared by Donna Seger, MD
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Donna Seger, MD
Tennessee Poison Center www.tnpoisoncenter.org
Poison Help Hotline: 1-800-222-1222