The management of life-threatening beta-blocker toxicity and its associated low cardiac output state is clinically challenging. Previous case reports and case series describe the use of hyperinsulinemia/euglycemia therapy in mono-ingestions of calcium channel blockers and mixed ingestions, including calcium channel and beta-blockers. In this case report we describe the use of high-dose insulin (10 IU/kg per hour) in a case of massive metoprolol ingestion (5 g) in which hypotension was unresponsive to conventional therapies. Although the metoprolol concentrations measured in plasma were approximately 100-200 times therapeutic concentrations, the pharmacokinetics appeared to be similar to therapeutic metoprolol dosing.
Page, C. B., Hacket, L. P., & Isbister, G. K. (2009). The use of high-dose insulin-glucose euglycemia in beta-blocker overdose: A case report. Journal of Medical Toxicology, 5(3), 139-143. https://doi.org/10.1007/BF03161225