Chomping at the Bit: A Descriptive Report on Pediatric Clenbuterol Ingestion

Abstract

Introduction: Clenbuterol hydrochloride is a selective beta-2 adrenergic agonist with uses in both humans and animals. Ingestions occurring within the United States are generally due to incidental ingestion of a veterinary product, use as a cutting agent for illicit substances, or illegal use for performance-enhancing purposes. Case Report: A four-and-a-half year-old male presented approximately two-and-a-half hours after an accidental ingestion of an unknown quantity of clenbuterol. Initial laboratory results and electrocardiogram were remarkable for hyperglycemia, hypokalemia, and hypophosphatemia, with an electrocardiogram demonstrating sinus tachycardia. Heart rate ranged from 126 to 147 beats per minute while other vitals remained within normal limits. The patient was observed for 24 hours and discharged with normalized vital signs, laboratory results, and electrocardiogram. Discussion: Clenbuterol hydrochloride is a beta-agonist with high potency, extended half-life, and bioavailability of 70% to 80%. Tachycardia occurs due to beta-1 receptor stimulation, as well as a homeostatic reflex to peripheral vasodilation. Hyperglycemia is not uncommon in exposures and intracellular shifting of potassium causes hypokalemia. Treatment is primarily supportive in nature, with hemodynamic management representing the primary focus of initial triage.

Clenbuterol: a new toxic substance in paediatrics

“…Clenbuterol is an oral, β-adrenergic agonist, which is relatively selective for β2 receptors 5. It is a globally accessible drug, licensed for use in some European countries as a bronchodilator 9.…”

“…ECG changes include sinus tachycardia, QT prolongation and arrhythmias 10. Metabolic effects include hyperglycaemia, hypokalaemia, hypophosphataemia, hypomagnesaemia and a high anion gap metabolic acidosis 5. These effects are transient, with complete resolution to baseline after drug elimination 10…”

“…A small number of cases of clenbuterol ingestion have been described in children and adolescents 5 8 14. Despite similarities in how children and adults present following clenbuterol ingestion, difficulties arise in paediatric patients being unable, or fearful of, admitting ingestion 5. These patients may also be unable to accurately quantify the dose they have ingested.…”

“…Adverse effects in adults are well documented, but there are limited data on effects in children or adolescents 3 4. Serious adverse effects include arrhythmia, hypotension and myocardial infarction, even in the absence of concomitant cardiovascular risk factors 5. Parents should be counselled as to the dangers these drugs pose and how to safeguard young people from accessing them.…”

Clenbuterol, salbutamol, and ractopamine in fresh meat products in Jilin province, China

“…Ingesting foods containing β-agonists increases the public's health risks, especially for athletes, which can lead to positive stimulant testing. [44][45][46] Limitation of study Our study had some limitations. First, sampling time difference at the retail market may have affected the residue level of the β-agonists during the monitoring study.…”