Late diagnosis of an outbreak of leanness-enhancing agent-related food poisoning.
BACKGROUND
Ractopamine is a leanness-enhancing agent approved in the United States and 26 other countries to reduce body fat content, increase muscle mass, and improve growth rate of certain food-producing animals. Other β-agonists with stronger pharmacologic effects, especially clenbuterol, had been illegally used as leanness-enhancing agents in the United States, China, and the European Union, and foodborne poisonings related to clenbuterol residue in meat or liver were rarely reported in the European Union and China. We describe an unusual outbreak of leanness-enhancing agent-related food poisoning in Taiwan and its associated diagnostic challenge.
Twelve patients presented to the emergency department of a regional hospital after having dinner together. Their clinical manifestations included nausea, vomiting, palpitation, facial flush, trunk or limb numbness, tremor, headache, weakness, chill, and dyspnea. Laboratory workup revealed the presence of hypokalemia, leukocytosis, and hyperglycemia. Poisoning attributable to β-agonists was suspected; however, the diagnosis of leanness-enhancing agent poisoning was delayed because there was no leftover meat for analysis and because the veterinary medicine was illegal in Taiwan. Clenbuterol and salbutamol were eventually detected in 10 patients' urine sample by using liquid chromatography-tandem mass spectrometry, and the concentrations ranged from 54 to 806 μg/L and from 0 to 4052 μg/L, respectively.


CONCLUSIONS
β-Agonist leanness-enhancing agent-related food poisonings are rarely encountered, especially in those countries where relevant veterinary medicines are banned, and may thus pose diagnostic challenge to both emergency physicians and clinical toxicologists.
Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Ming-Ling
ML
Wu
Jou-Fang
JF
Deng
Yi
Y
Chen
Wei-Lan
WL
Chu
Dong-Zong
DZ
Hung
Chen-Chang
CC
Yang
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000506:poisoning*; D000328:Adult; D000420:Albuterol / Q000506:poisoning* / Q000652:urine; D000818:Animals; D002645:Chickens; D002648:Child; D002976:Clenbuterol / Q000506:poisoning* / Q000652:urine; D057210:Delayed Diagnosis; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D005260:Female; D005517:Foodborne Diseases / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D006133:Growth Substances / Q000506:poisoning*; D006801:Humans; D008297:Male; D008460:Meat / Q000009:adverse effects; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
D000318:Adrenergic beta-Agonists; D006133:Growth Substances; D000420:Albuterol; D002976:Clenbuterol