Inadvertent Intoxication with Salbutamol, Treated with Hemodialysis: A Case Report and Brief Review of the Literature.

Autor: Bezeljak N; Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia., Jerman A; Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia., Grenc D; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.; Department of Toxicology, University Medical Centre Ljubljana, Ljubljana, Slovenia., Krzisnik Zorman S; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.; Center for Intensive Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Jazyk: angličtina
Zdroj: Case reports in nephrology and dialysis [Case Rep Nephrol Dial] 2024 Jun 18; Vol. 14 (1), pp. 88-96. Date of Electronic Publication: 2024 Jun 18 (Print Publication: 2024).
DOI: 10.1159/000536523
Abstrakt: Introduction: Salbutamol is a moderately selective beta-2-adrenergic agonist. Various side effects can occur because of beta-1 and beta-2 receptor activation. Due to the large volume of distribution, it is not considered dialyzable.
Case Presentation: A patient with salbutamol intoxication, which developed as a result of a medical error in a patient with sepsis, Down syndrome, and liver cirrhosis, is presented. Initial treatment was partially successful and antibiotic adjustments were made. After his respiratory failure worsened, the patient needed non-invasive ventilation, and previously undiagnosed chronic obstructive pulmonary disease was suspected. He was prescribed intravenous methylprednisolone but accidently received 5 mg of salbutamol (albuterol), which led to immediate severe arrhythmic tachycardia with hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was commenced to decrease suspectedly highly elevated serum salbutamol levels. After 30 min, sinus rhythm with normocardia was observed. After the hemodialysis termination, no rebound tachycardia was noted, but due to severe septic shock, the hypotension was ongoing and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol and data from literature do not support the view that hemodialysis was the cause of the described improvement: the total amount of the drug cleared was very small (2.8% of total dose).
Conclusion: Our results confirm a large volume of salbutamol distribution; the measured levels are within observed therapeutic levels; and the measured half-life time during hemodialysis (3.1 h) is comparable to observed half-life times in therapeutic settings. The observed favorable clinical benefit associated with dialysis may be fortuitous, highlighting potential bias toward positive clinical outcomes and unproven ("salvage") therapies.
Competing Interests: The authors declare that they have no competing interests.
(© 2024 The Author(s). Published by S. Karger AG, Basel.)
Databáze: MEDLINE
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