{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:26:51Z","timestamp":1782728811360,"version":"3.54.5"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,4,22]],"date-time":"2015-04-22T00:00:00Z","timestamp":1429660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:p>Adrenergic \u03b2\u2010antagonists, commonly known as \u03b2\u2010blockers, are prescribed for many indications including hypertension, heart failure, arrhythmias, and migraines. Metoprolol is a moderately lipophilic \u03b2\u2010blocker that in overdose causes direct myocardial depression leading to bradycardia, hypotension, and the potential for cardiovascular collapse. We describe the case of a 59\u2010year\u2010old man who intentionally ingested ~7.5\u00a0g of metoprolol tartrate. Initial treatment of bradycardia and hypotension included glucagon, atropine, dopamine, and norepinephrine. Despite these treatment modalities, the patient developed cardiac arrest. Intravenous lipid emulsion (<jats:styled-content style=\"fixed-case\">ILE<\/jats:styled-content>) and hyperinsulinemia\/euglycemia (<jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content>) therapies were initiated during advanced cardiac life support and were immediately followed by return of spontaneous circulation. Further treatment included gastric lavage, activated charcoal, continued vasopressor therapy, and a repeat bolus of <jats:styled-content style=\"fixed-case\">ILE<\/jats:styled-content>. The patient was weaned off vasoactive infusions and was extubated within 24\u00a0hours. <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content> therapy was continued for 36\u00a0hours after metoprolol ingestion. A urine \u03b2\u2010blocker panel using mass spectrometry revealed a metoprolol concentration of 120\u00a0ng\/ml and the absence of other \u03b2\u2010blocking agents. To date, no clear treatment guidelines are available for \u03b2\u2010blocker overdose, and the response to toxic concentrations is highly variable. In this case of a life\u2010threatening single\u2010agent metoprolol overdose, the patient was successfully treated with <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ILE<\/jats:styled-content> therapy. Due to the increasing frequency with which <jats:styled-content style=\"fixed-case\">ILE<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content> are being used for the treatment of \u03b2\u2010blocker overdose, clinicians should be aware of their dosing strategies and indications.<\/jats:p>","DOI":"10.1002\/phar.1579","type":"journal-article","created":{"date-parts":[[2015,4,22]],"date-time":"2015-04-22T03:01:22Z","timestamp":1429671682000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Successful Treatment of a Massive Metoprolol Overdose Using Intravenous Lipid Emulsion and Hyperinsulinemia\/Euglycemia Therapy"],"prefix":"10.1002","volume":"35","author":[{"given":"Cassie A.","family":"Barton","sequence":"first","affiliation":[{"name":"Department of Pharmacy Oregon Health &amp; Science University Portland 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