Treatment of atenolol overdose in a patient with renal failure using serial hemodialysis and hemoperfusion and associated echocardiographic findings

A 28-y-old male with end stage renal failure (ESRF) received an overdose of atenolol. Subsequent cardiac arrest and prolonged cardiogenic shock requir ed aggressive pharmacologic support, intraaortic balloon pump insertion, an d mechanical ventilation. Four hemodialyses with charcoal hemoperfusion wer e performed over 72 h. Plasma atenolol levels decreased from 7.4 mg/L to 2. 1 mg/L although significant rebound occurred between dialyses. Transthoraci c echocardiogram showed global hypokinesis with an ejection fraction (EF) o f 5-10% prior to cardiac arrest, compared to baseline and following EF's of approximately 35%. Our experience supports hemodialysis for ESRF patients with atenolol toxicity.