Salbutamol abuse/overdose
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Redistributive hypokalaemia: case report A 10-year-old boy developed redistributive hypokalaemia following abuse of salbutamol at an overdose [route, dosage and duration of treatment to reaction onset not stated]. The boy with various a complex medical history was admitted to the emergency department due to muscle pain, palpitations, tremors, headache of 3-hour duration at the age of 13 years. At the time of physical examination, he was euvolemic, pale and sweating. Cardiac auscultation showed rhythmic tachycardia without murmurs or friction and tachypnoea. He was noted to have weakness of the lower limbs and distal hand tremor. His parents showed multiple medical results and 16 discharge reports from different hospitals. The current clinical symptoms started when he was 10 years old and since then he had many recurrent episodes of severe hypokalaemia, which had led to frequent hospital admissions. One of the admissions required ICU stay due to long QT syndrome. He underwent extensive investigations and hypokalaemia was noted. Hormone analysis showed aldosterone level of 0.06 nmol/L following 30 minutes rest and urinary aldosterone was 7.0 nmoL/24hr. ECG demonstrated sinus tachycardia and a QT interval of 460ms. The boy received potassium replacement. After 12 hours, the plasma potassium level normalised. Two days following admission, he became asymptomatic with potassium level of 4.4 mmol/L (8:45am). However, he suddenly developed intense headache, distal tremor and tachycardia at 2:15pm. The serum potassium level decreased to 3.4 mmol/L. Then, over a 2h interval and without any treatment, his symptoms disappeared gradually. Then, he was discharged with oral potassium supplements. His presentation suggested adrenergic crisis; hence, a possible overdose of β-adrenergic agonist drugs was suspected. The analysis of blood samples obtained on the day of discharge showed plasma salbutamol levels of 3 ng/mL and 65 ng/mL at 8:45 am and 2 15pm, respectively. However, he had no medical indication for salbutamol and his family denied use of salbutamol. All these findings confirmed a diagnosis of redistributive hypokalaemia following hidden abuse of salbutamol at an overdose in the setting of a possible factitious disorder (Munchausen syndrome). Aliaga CA, et al. Severe hypokalemia secondary to abuse of beta-adrenergic agonists in a pediatric patient: Case report. Jornal Brasileiro de Nefrologia 42: 250-253, No. 2, 30 803500036 May 2019. Available from: URL: http://doi.org/10.1590/2175-8239-JBN-2019-0020
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Reactions 5 Sep 2020 No. 1820
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