Combined Beta Blocker and Calcium Channel Blocker Overdose

Author: Shehab Elmoghazy, Ahmed Said / Editor: Stephen Sheridan / Codes: MHC1, MHP4, PhC1, PhP2, RP7, SLO3, SLO7 / Published: 16/01/2026

A 38-year-old female patient presents to the emergency department (ED) with an overdose of Bisoprolol 15 × 10 mg (150 mg total) and Amlodipine 15 × 10 mg (150 mg total). She reported that the time of ingestion was 4 hours ago.

Examination findings:

• Airway patent; speaking in full sentences but drowsy (GCS 14)
• Respiratory rate 18 min⁻¹, SpO₂ 98 % on air
• BP 60/40 mmHg, HR 30 bpm (sinus bradycardia)
• Capillary blood glucose 2.5 mmol L⁻¹
• Peripheral cool; capillary refill > 4 s
• ECG: sinus bradycardia, PR prolongation (220 ms), narrow QRS
• Initial venous blood gas: pH 7.18, lactate 6.5 mmol L⁻¹, K⁺ 3.2 mmol L⁻¹