title: Albuterol overdose: a case report and differential diagnosis.
abstract: The increase in the use of selective beta 2 agonists as first-choice agents in the therapy of asthma has resulted in a concomitant increase in overdoses and other therapeutic misadventures. This case describes a 22-month-old child who ingested a large overdose of albuterol, resulting in an acute syndrome consisting of agitation, tremulousness, marked hyperglycemia of > 320 mg/dl (17.8 mmol/L), ketonuria, and hypokalemia. Such toxicity has generally been reported only in diabetics or pregnant patients. These findings and a brief review of the pharmacology and toxicology of beta 2 agonists are detailed, with special emphasis on the differential diagnosis of overdoses characterized by hyperglycemia, hypokalemia, agitation, and tremulousness. A system of ordering the relative toxicity of these (and other) drugs is proffered using the exposure-case fatality rate (ECFR) as a crude measure of clinical toxicity (while delineating its shortcomings). Applying the ECFR (using American Association of Poison Control Centers' data base) to beta 2 agonist overdoses indicates that the resulting clinical syndrome, while troublesome, generally results in a benign outcome.
authors.affiliation: Children's Hospital of Alabama, Regional Poison Control Center, Birmingham 35233.
authors.forename: W D
authors.initials: WD
authors.lastname: King
authors.forename: M
authors.initials: M
authors.lastname: Holloway
authors.forename: P A
authors.initials: PA
authors.lastname: Palmisano
mesh_terms: D000420:Albuterol / Q000494:pharmacology / Q000506:poisoning*; D003937:Diagnosis, Differential; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007223:Infant; D011041:Poisoning / Q000175:diagnosis
chemical_list: D000420:Albuterol