Hypoglycemia After Albuterol Overdose in a Pediatric Patient

Abstract

Albuterol overdose can lead to tachycardia, hypotension, tremor, hypokalemia, and hyperglycemia in children. Hypoglycemia had been previously reported in only one child. We describe a 3-year-old boy who ingested high-dose albuterol in this report. On arrival to the emergency department, the child was agitated and had noticeable restlessness, sinus tachycardia, mild hypokalemia (3.2 mEq/L), and hyperglycemia (187 mg/dL). Activated charcoal and intravenous hydration were given, and electrocardiogram monitoring was performed. Sinus tachycardia resolved within 4 to 6 hours. Hypoglycemia (45 mg/dL) was identified 4 hours after admission. The child recovered uneventfully within 24 hours with glucose replacement. This case suggests that hypoglycemia could be a late complication of acute albuterol overdose; thus, the period of observation should be extended in these cases.

Unintentional Oral Beta Agonist Overdose

“…It is important to stress that in overdose situations, receptor specificity may be lost, with tachycardia resulting from b 1 or b 2 stimulation or from both. 1 All children with significant b-sympathomimetic overdose should therefore undergo serial blood glucose measurements for 16 hours after ingestion. 11 b 2 -Adrenergic agonists initially cause a rapid rise in plasma concentration of glucose through activation of stress mechanisms, but significant hypoglycemia can become evident as late as 16 hours after the ingestion 12 ; the increase in insulin is believed to be secondary to direct stimulation of b 2 -receptor cells in the pancreas.…”

“…10 In patients without underlying heart disease, such as in our patient, abnormalities in cardiac conduction are extremely unusual, even when changes are evident on electrocardiography. 1 Most reports of albuterol intoxication are from over 10 years ago, because this drug is now used predominantly by inhalation where the systemic dose is minimal and the incidence of adverse reactions is low. 1 All children with significant b-sympathomimetic overdose should therefore undergo serial blood glucose measurements for 16 hours after ingestion.…”

“…1 Theophyline has a low therapeutic index and may be dangerous when overdosed, 2 and the oral route for albuterol should also be avoided for the same reason. 1 Theophyline has a low therapeutic index and may be dangerous when overdosed, 2 and the oral route for albuterol should also be avoided for the same reason.…”

Beta‐blocker‐associated hypoglycaemia: New insights from a real‐world pharmacovigilance study

“…[43][44][45] Hypoglycaemia following salbutamol (albuterol) overdose has also been reported in some paediatric patients treated with this drug for asthma. 46,47 Potential confounders in causality assessments, such as protopathic bias and role of co-medication, need to be considered, as previous studies have found that concomitantly administered antidiabetic drugs may depict a false reported risk of hypoglycaemia for a variety of drug classes. 23,24 Furthermore, confounding by indication may represent a relevant issue, as some underlying diseases or comorbid conditions-for which β-blockers are indicated-themselves pose a higher risk of hypoglycaemia possibly because of lower glycogen reserves and higher rates of glucose use.…”

Morphological analysis of T-wave in vectorcardiographic leads system by a bi-Gaussian approach in patients under effect of salbutamol

“…Episodes of hypoglycaemia and drugs as salbutamol in adults and children induce abnormalities in cardiac repolarization [8], [10] which is also modulated by autonomic neuropathy [9]. Therefore, it is necessary more sophisticated analysis of T wave morphology to reliably detect the onset of hypoglycaemia.…”