1456 Fatal propranolol overdoses reported to the UK National Poisons Information Service (NPIS) over 5 years 01/01/2017–31/12/2021

Aims, Objectives and Background Propranolol is widely prescribed between 2007 2017 dispensing in the UK increased by some 41%. In same period, deaths England Wales following propranolol overdose 205%. Method Design We retrospectively reviewed cases of fatal poisoning reported to NPIS, 01/01/2017 31/12/2021 understand demographics these exposures, doses involved treatments administered. Results Conclusion There were 46 fatalities (aged 14–70 years) with 57% (n=26) them being less than 40 years age, majority female (77%; n=20). Thirteen only 33 mixed mean number co-ingestants was two, a maximum 13. An antidepressant co-ingested 21 cases. The dose ingested documented 23/46 cases, median 3,200 mg (IQR 1,920–4,480 mg) three patients exceeded 7,000 mg. Cardiac arrest prior contact NPIS recorded 41/46 Fourteen (34%) occurred hospital twenty-three out-of-hospital (56%). Patients received: sodium bicarbonate (n=30, 65%), glucagon bolus and/or infusion (n=38, 83%), high insulin/dextrose (n=36, 78%), inotropes or vasopressors intralipid (n=25, 54%) ECMO commenced two insulin administered known 15 (median 4 unit/kg/hour). Doses more equal 8 unit/kg/hour given 7 (maximum 10 cases). Young adults particularly females accounted for fatalities. almost half all an co-ingested. Clinicians should be aware potential rapid deterioration severe clinical outcomes overdose. Rapid access expert advice available through National Poisons Information Service strongly recommended order optimise use treatments.