Blood Purification in Toxicology:​Reviewing the Evidence and Providing Recommendations

ß-adrenergic antagonists (ß-blockers)

(view full publication)

​

General Recommendation and Indications

• Propranolol

  • In patients severely poisoned with propranolol, we recommend against performing ECTR in addition to standard care rather than standard care alone (strong recommendation, very low quality evidence).​

• Atenolol

  • In patients severely poisoned with atenolol and kidney impairment*, we suggest performing ECTR in addition to standard care rather than standard care alone when refractory bradycardia and hypotension is present (weak recommendation, very low quality evidence).

  • In patients severely poisoned with atenolol and normal kidney function, we make no recommendation for or against performing ECTR in addition to standard care rather than standard care alone (no recommendation, very low quality evidence)

• Sotalol

  • In patients severely poisoned with sotalol and kidney impairment*, we suggest performing ECTR in addition to standard care rather than standard care alone when refractory bradycardia and hypotension and/or recurrent torsade de pointes is present (weak recommendation, very low quality of evidence).

  • In patients severely poisoned with sotalol with normal kidney function, we make no recommendation for or against performing ECTR in addition to standard care rather than standard care alone (no recommendation, very low quality evidence).

  • In patients severely poisoned with sotalol, we suggest against performing ECTR solely based on the QT interval (weak recommendation, very low quality evidence)

 

Choice of ECTR

• In patients severely poisoned with atenolol or sotalol requiring ECTR: when all modalities are available, we recommend using intermittent hemodialysis rather than any other type of ECTR (strong recommendation, very low quality evidence).

 

Cessation of ECTR

• In patients severely poisoned with atenolol or sotalol requiring ECTR, we recommend stopping ECTR based on clinical improvement (strong recommendation, very low quality of evidence)

 

​

 

​

 

​

​