Methylene blue reverses recalcitrant shock in β-blocker and calcium channel blocker overdose

BMJ Case Rep. 2013 Jan 18:2013:bcr2012007402. doi: 10.1136/bcr-2012-007402.


β-blocker and calcium channel blocker toxicity generally present with bradycardia and hypotension. A 69-year-old woman presented after a suicide attempt with a β-blocker and calcium channel blocker overdose. Her blood pressure was 69/35 mm Hg and her HR was in the 40s. She was treated with calcium chloride, glucagon, a dextrose-insulin infusion and three vasopressors, but remained hypotensive. She suffered two cardiac arrests and required a transvenous pacemaker. When all interventions failed, she was started on a methylene blue infusion for refractory vasodilatory shock which resulted in a dramatic improvement in her blood pressure. The patient was successfully weaned off all vasopressors and from mechanical ventilation without any end-organ damage.

Publication types

  • Case Reports

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects*
  • Aged
  • Calcium Channel Blockers / adverse effects*
  • Drug Overdose / complications*
  • Drug Overdose / drug therapy
  • Enzyme Inhibitors / therapeutic use
  • Female
  • Humans
  • Methylene Blue / therapeutic use*
  • Shock / chemically induced
  • Shock / drug therapy*


  • Adrenergic beta-Antagonists
  • Calcium Channel Blockers
  • Enzyme Inhibitors
  • Methylene Blue