Acute nontraumatic rhabdomyolysis in a Greyhound after albuterol toxicosis

Abstract

Objective To describe the clinical features of rhabdomyolysis due to albuterol toxicosis in a Greyhound. Case summary A 4‐year‐old neutered male Greyhound was presented for albuterol toxicosis leading to severe hypokalemia and respiratory paralysis. After 3 hours of mechanical ventilation, pigmenturia and marked enlargement, firmness, and pain of the left thigh muscles were noted. Severe hyperkalemia and cardiac arrhythmias were identified after turning the patient. After discontinuation of mechanical ventilation, other muscles became involved, and the patient developed acute kidney injury and concern for multiple organ dysfunction syndrome over the next 5 days. On day 6, the patient was euthanized, and necropsy revealed myocardial and skeletal muscle necrosis, myoglobinuria, and acute tubular degeneration. New or unique information provided To the authors’ knowledge, this is the first case of albuterol toxicosis leading to rhabdomyolysis.

Rebound hyperkalemia in a dog with albuterol toxicosis after cessation of potassium supplementation

“…In addition, skeletal muscle is rich in beta adrenoreceptors, and muscle remodeling induced by excessive ß2 agonism may also contribute to muscle necrosis and resultant rhabdomyolysis. As a result, potassium release from skeletal muscles results in hyperkalemia, and myoglobin release from myocytes causes myoglobinuria and subsequent acute tubular necrosis 1 . In our dog, rhabdomyolysis is considered unlikely.…”

“…In this report of albuterol toxicosis, the dog was initially noted to have hypokalemia, hyperlactatemia, and hyperglycemia, all of which have been previously documented with albuterol toxicosis in dogs 1,3 . Hypokalemia is caused by direct ß‐adrenergic stimulation of the Na/K‐ATPase pumps in the liver and muscle cells, leading to an intracellular influx of potassium 3 .…”

“…Albuterol, a selective ß2‐adrenergic agonist, is used for its bronchodilator effects in the treatment of asthma in human, canine, and feline patients 1 . Albuterol toxicosis is encountered in veterinary medicine, as dogs tend to chew on albuterol‐containing inhalers, resulting in sudden massive exposures 2 .…”

“…Albuterol toxicosis is encountered in veterinary medicine, as dogs tend to chew on albuterol‐containing inhalers, resulting in sudden massive exposures 2 . Acute toxicosis can result in significant clinical and laboratory abnormalities, including cardiac arrhythmias, weakness, hypokalemia, hypomagnesemia, hyperglycemia, and hyperlactatemia 1–4 . These effects are mediated by the stimulatory effects of ß2‐adrenergic agonists on the pancreatic islet cells and cell membrane Na/K‐ATPase pumps, as well as the direct increase in glycogenolysis 3,5 .…”

Methodology‐related pseudohyperkalemia associated with marked muscle enzyme leakage in a dog

“…Interestingly, however, initial comparative potassium concentrations generated by the Cobas analyzer were within or only marginally above the reference interval. It is unknown why hyperkalemia was not observed when potassium was initially and repeatedly measured with the Cobas analyzer because CK activities were high enough to anticipate hyperkalemia compared to other reports 16,17 . Compensatory renal potassium excretion was a likely contributing reason.…”