Unintentional Oral Beta Agonist Overdose

Abstract

An 18-month-old male infant with oral albuterol intoxication was admitted to our pediatric emergency medicine unit with agitation, moderate hypokalemia (2.36 mEq/L), and hyperglycemia (180 mg/dL). His initial electrocardiogram showed sinus tachycardia with a low-amplitude T waves. He was admitted for observation, intravenous hydration was started with added potassium, blood glucose levels were closely monitored along with serum potassium and magnesium, and serial electrocardiography was performed. It should be stressed that as an oral bronchodilator, albuterol does not improve symptoms of asthma, and it can lead to severe complications, which can be avoided when this drug is delivered by inhalation or by a metered dose inhaler.

Clenbuterol: a new toxic substance in paediatrics

“…Our local clinical biochemist suggested theophylline, also a methylxanthine, as a potential cause, having previously seen cases similar to this. The features of acute chest pain, palpitations and vomiting, with hypokalaemia, hypophosphataemia and hyperglycaemia on laboratory testing and the ECG demonstrating sinus tachycardia and ischaemic changes, matched reports of β-agonist toxicity 2 8. However, β-agonist toxicity was considered unlikely, given the absence of comorbidities and daily medications, plus the family denied any β-agonist medications being kept in the household.…”

“…It is a globally accessible drug, licensed for use in some European countries as a bronchodilator 9. At significant concentrations, clenbuterol produces a toxidrome of nausea, vomiting, tremor, tachycardia and tachypnoea 8 10. Peak serum effect is seen within 2–3 hours after ingestion.…”

“…A small number of cases of clenbuterol ingestion have been described in children and adolescents 5 8 14. Despite similarities in how children and adults present following clenbuterol ingestion, difficulties arise in paediatric patients being unable, or fearful of, admitting ingestion 5.…”

“…These patients may also be unable to accurately quantify the dose they have ingested. Among this cohort, ingestion may be accidental in younger children or for body-enhancing purposes, among vulnerable adolescents 8 14. As in this case, they may also be used for deliberate self-harm.…”

Severe hypokalemia secondary to abuse of β-adrenergic agonists in a pediatric patient: Case report

“…In our patient, gastrointestinal and renal potassium wasting was easily ruled out by anamnesis, tests, and history, and the associated clinical signs of tremors, tachycardia, headache, and sweating were highly suggestive of adrenergic crisis. The described symptoms are frequent side effects of β-adrenergic agonist overdose as a result of peripheral vascular dilatation 9 . On the other hand, the rapid and sustained normalization of serum potassium levels without the need for further oral supplements was also suggestive of a redistribution effect rather than a real potassium loss.…”