Hi,
In refractory cases of b-blocker use and anaphylaxis, success has been
achieved with glucagon, which may increase cardiac cyclic AMP, thereby
enhancing cardiac output. It can be used intravenously and repeated every 5
mins.Epinephrine would not be very effective,would need higher doses with
associated perils.
Some proponents say that in patients receiving a beta-adrenergic blocker who
do not respond to epinephrine, glucagon, IV fluids, and other therapy, a
risk/benefit assessment rarely may include the use of isoproterenol ( a beta
agonist with no alpha-agonist properties). Although isoproterenol may be
able to overcome depression of myocardial contractility caused by beta
blockers, it also may aggravate hypotension by inducing peripheral
vasodilation and may induce cardiac arrhythmias and myocardial necrosis. If
a decision is made to administer isoproterenol intravenously, the proper
dose is 1 mg in 500 mL D5W titrated at 0.1 mg per kg per minute; this can be
doubled every 15 minutes. Adults should be given approximately 50 percent of
this dose initially. Cardiac monitoring is necessary and isoproterenol
should be given cautiously when the heart rate exceeds 150 to 189 beats per
minute.
Ayan Sen
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