A patient is receiving IV metoprolol and has HR 44 bpm with SBP 88 mmHg. What is the most appropriate action?

• A. Hold the dose and notify the physician; monitor hemodynamics and be prepared to treat bradycardia or hypotension per protocol.
• B. Increase the dose.
• C. Continue the infusion.
• D. Administer intravenous fluids immediately.

Answer: (A)

Metoprolol lowers heart rate and blood pressure. A heart rate of 44 and a systolic BP of 88 indicate significant bradycardia with hypotension, meaning the patient isn’t being adequately perfused and the drug is likely causing the problem. The safest and most appropriate action is to stop the metoprolol infusion and immediately notify the physician so they can decide how to adjust therapy and manage the patient. While you wait, keep the patient on continuous hemodynamic monitoring and be ready to treat bradycardia or hypotension according to the protocol (such as giving atropine for symptomatic bradycardia or initiating other measures if indicated). Increasing the dose would worsen the issue, and continuing the infusion risks further deterioration. Administering IV fluids right away isn’t the best sole action because the underlying cause is the beta-blocker effect; fluids may be used as part of the overall plan if hypotension persists, but the priority is stopping the offending drug and escalating care per protocol.