Characterization of pediatric beta-adrenergic antagonist ingestions reported to the National Poison Data System from 2000-2020

Document Type


Publication Date



Emergency Medicine

Journal Title

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine


BACKGROUND: When ingested by children, small quantities of beta-adrenergic antagonists (BAA) are described as dangerous, and even potentially lethal ("one pill can kill"). We characterize demographics, clinical characteristics, and the rate of serious outcomes amongst pediatric patients with reported BAA ingestions. METHODS: Retrospective review of United States patients < 20-years-old with reported single-agent BAA ingestions presenting to a healthcare facility between January 2000 and February 2020 for whom a poison control center (PCC) was consulted. Data was abstracted from the National Poison Data System (NPDS). Medical outcomes were assessed by the NPDS scale of no effect, minor effect, moderate effect, major effect, and death. All relevant NPDS fatality narratives were reviewed. RESULTS: 35,436 reported exposures were identified. 29,155 (82.3%) were < 6-years-old, of which 29,089 (99.8%) were unintentional. 25 patients (< 0.1%) < 6-years-old had major effects. 2,316 (8.8%) of patients with no/mild effects were admitted to a critical care unit. Of all cases, 1,460 (4.1%) had hypotension and 1,403 (4.0%) had bradycardia. 119 (0.3%) developed hypoglycemia. The only four fatalities resulted from intentional ingestions in patients > 10-years-old who sustained cardiac arrest in the pre-hospital setting. CONCLUSIONS: Reported BAA ingestions in this multi-year national pediatric cohort caused infrequent toxicity, and no fatalities resulted from an unintentional ingestion. The frequency of bradycardia, hypotension, and hypoglycemia were low. While severely poisoned patients require aggressive treatment, 8.8% of patients were admitted to a critical care unit despite having no or mild effects, which suggests an opportunity to reduce resource utilization.