Acute clenbuterol overdose resulting in supraventricular tachycardia and atrial fibrillation

Abstract

Objective: We are presenting a case illustrating the complex metabolic and rhythm disturbances associated with acute clenbuterol intoxication.Background: Clenbuterol is a long-acting β 2 -adrenergic agonist primarily used in veterinary medicine in the United States. It has become a common drug of abuse by body builders because of its reported anabolic and lipolytic properties. In this case report, a body builder using veterinary clenbuterol developed significant electrolyte and cardiac manifestations.Case Report: A 31-year-old man presented to the emergency department approximately 30 minutes after ingesting 1.5 ml (a tenfold dosing error) of Ventipulmin ® syrup (72.5 mcg/ml clenbuterol HCl). The product was brought to the emergency department (ED) by the patient. He reported no current use of anabolic steroids. He presented in an anxious state with complaints of palpitations and shortness of breath. Vital signs upon examination were as follows: BP, 122/77 mmHg (16.3/10.3 kPa); HR 254 bpm; RR, 22 bpm; Temperature, 97.1°F (36°C); and oxygen saturation, 100% on ambient air. His electrocardiogram (ECG) demonstrated supraventricular tachycardia with a ventricular rate of 254 bpm. Esmolol was recommended for rate control after the unsuccessful use of adenosine and diltiazem. Laboratory studies showed potassium, 2.1 mmol/L; magnesium, 1.3 mg/dL (0.54 mmol/L); phosphorus, 1.0 mg/dL (0.32 mmol/L); serum glucose, 209 mg/dL (11.6 mmol/L); creatinine, 0.8 mg/dL (70.7 µmol/L); AST, 20 U/L; ALT, 55 U/L; hemoglobin, 12.6 g/dL (126 g/L); CPK total, 87 U/L; and troponin I, 0.23 µg/L. The patient's urine was negative for any drugs of abuse. Clenbuterol levels were not obtained. A second ECG, 16 hours post ingestion, reflected atrial fibrillation with a ventricular rate of 125 to 147 bpm. On hospital day 3, he was electively cardioverted to sinus rhythm; heart rate and rhythm returned to normal, and he was discharged with oral metoprolol.Discussion: Clenbuterol is approved for use in countries outside the U.S. as a bronchodilator for the treatment of acute asthma exacerbations in humans. Although clenbuterol is not a steroid hormone, it possesses anabolic properties that increase muscle mass. Its longer duration of action compared to other β 2 -agonists (such as albuterol) make it a desired agent for body-building because of its high and prolonged serum level. The mechanism for the short and long-term cardiovascular complications of clenbuterol is complex. The anabolic effects of clenbuterol are associated with its β 2 -adrenoreceptor agonist activity on striated skeletal muscles. In addition, clenbuterol promotes lipolysis through adipocyte β 3 -adrenoreceptors.Conclusion: Considering the significant number of body-building enthusiasts, physicians will continue to encounter clenbuterol abuse in their clinical practices.

Toxicity of Weight Loss Agents

“…In addition, it has specific anabolic activity and increased lipolysis that is not seen with other beta agonists. Abuse is often observed in the setting of livestock development and bodybuilding in order to increase lean muscle [56,57]. Acute clenbuterol toxicity presents with tachycardia, tachyarrhythmias, palpitations, anxiety, tremor, and shortness of breath; hypokalemia is often seen with its use as well.…”

Efecto del clorhidrato de clembuterol en la ganancia de peso y lesiones histológicas en ratones

“…Sin embargo, se ha demostrado que el consumo de carne contaminada con CCL produce efectos adversos a la salud humana, debido a la estimulación del sistema cardiovascular. Sin registrar la concentración exacta, se ha informado que el consumo de carne contaminada con CCL con una dosis "moderada" produce adormecimiento de las manos, temblores musculares, nerviosismo y cefalea, y en dosis "más elevadas", se acentúa la taquicardia, lo que puede ocasionar necrosis del miocardio (14,23,24).…”

Evaluation of clenbuterol-induced changes in blood biochemical parameters in white mice

“…Clenbuterol is a bronchodilator which is FDA-approved for treatment chronic obstructive pulmonary disease (COPD) in horse and nonlacting cattle 1,2 . Clenbuterol binds selectively to β 2 -receptor in smooth muscles and consequently causing muscle relaxation.…”

“…Clenbuterol binds selectively to β 2 -receptor in smooth muscles and consequently causing muscle relaxation. The recommended dose of clenbuterol for treatment COPD in veterinary is 0.8µg/kg twice daily 1,3 . At doses 5-10 folds higher than therapeutic dose, clenbuterol induces weight gain, increases muscle and decreases adipose tissue mass 4 .…”

“…At doses 5-10 folds higher than therapeutic dose, clenbuterol induces weight gain, increases muscle and decreases adipose tissue mass 4 . Due to its anabolic effects, clenbuterol is illegally used in animal production as a promoting agent and is abused by sportsmen for bodybuilding 1,5,6 . The chemistry structure of clenbuterol is similar to derivations from endogenous catecholamines.…”