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 required aggressive pharmacologic support, intraaortic balloon pump insertion, and mechanical ventilation. Four hemodialyses with charcoal hemoperfusion were performed over 72 h. Plasma atenolol levels decreased from 7.4 mg/L to 2.1 mg/L although significant rebound occurred between dialyses. Transthoracic echocardiogram showed global hypokinesis with an ejection fraction (EF) of 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.