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Clenbuterol toxicity
From WikEM
(Redirected from Clenbuterol)
This page refers to Clenbuterol overdose not dosing of Clenbuterol
Contents
Background
- Clenbuterol is found as an adulterant in both cocain and heroin. There have been many reports of clenbuterol overdoses and outbreaks.[1] It is a long acting B2-agonist used internationally and within the US mainly in veterinary medicine as bronochodilator. In addition to being added into heroin it is also used to increase lean mass of livestock and in racehorses[2]
- Athletes and body builders also abuse clenbuterol in order to increase muscle mass and decrease body fat.
- Street Name: Clen
- Formulation: Tablet or syrup
- Half Life: 25-39 hrs
Clinical Features
- Nausea
- Palpitations
- Chest pain
- Dyspnea
- Tachycardia
- Mydriasis
- Tremors
- Agitation and COnfusion
If mixed with cocaine there will be a sympathomimetic toxidrome
Differential Diagnosis
Altered mental status and fever
- Infectious
- Sepsis
- Meningitis
- Encephalitis
- Cerebral malaria
- Other
Toxidrome Chart
| Finding | Cholinergic | Anticholinergic | Sympathomimetic | Sympatholytic^ | Sedative/Hypnotic |
| Example | Organophosphates | TCAs | Cocaine | Clonidine | ETOH |
| Temp | Nl | Nl / ↑ | Nl / ↑ | Nl / ↓ | Nl / ↓ |
| RR | Variable | Nl / ↓ | Variable | Nl / ↓ | Nl / ↓ |
| HR | Variable | ↑ | ↑ (sig) | Nl / ↓ | Nl / ↓ |
| BP | ↑ | ↑ | ↑ | Nl / ↓ | Nl / ↓ |
| LOC | Nl / Lethargic | Nl, agitated, psychotic, comatose | Nl, agitated, psychotic | Nl, Lethargic, or Comatose | Nl, Lethargic, or Comatose |
| Pupils | Varriable | Mydriatic | Mydriatic | Nl / Miotic | |
| Motor | Fasciculations, Flacid Paralysis | Nl | Nl / Agitated | Nl | |
| Skin | Sweating (sig) | Hot, dry | Sweating | Dry | |
| Lungs | Bronchospasm / rhinorrhea | Nl | Nl | Nl | |
| Bowel Sounds | Hyperactive (SLUDGE) | ↓ / Absent | Nl / ↓ | Nl / ↓ |
- ^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
- Withdrawal from substances have the opposite effect
Evaluation
Lab testing may show:
- Hyperglycemia
- Hypokalemia
- Hypophosphatemia
The effects are due to the β-agonist effects. In patients with associated chest pain, a cardiac workup (ECG, and troponin) should be performed.
Management
Supportive care should include:
- IV fluids
- Potassium repletion
- Benzodiazepine administration for agitation
- Evaluation for Rhabdomyolysis [3]
Severe Overdoses
- In an isolated severe overdose without associated cocaine igestions, β-blockade can be given via IV metoprolol, labetolol or esmolol
- Beta blockade may reverse the associated hypotension from the excessive Beta agonism of the clenbuterol[4]
- Do not administer beta blocker if there is a chance of associated cocaine use. Diltiazem is an alternative for these situations[4]
Disposition
- Most patients require admission due to the long half life of clenbuterol
- Patients with severe symptoms or those with myocardial ischemia should be admitted for continued monitoring and appropriated cardiac managment[5]
- Contact Poison Control Center
See Also
External Links
CDC MMWR Atypical Reactions Associated With Heroin Use — Five States, January–April 2005
References
- ↑ CDC. Atypical reactions associated with heroin use - five states, Jan-April 2015. MMWR. 20025;54(32):793-796
- ↑ Hoffman RS, Kirrane BM, et al. A descriptive study of an outbreak of clenbuterol-containing heroin. Ann Emerg Med. 2008;52(5):548-553
- ↑ O'Connor AD, Padilla-Jones A, Gerkin AD, et al. Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants. J Med Toxicol 2014
- ↑ 4.0 4.1 Barry AR, Graham MM. Case report and review of clenbuterol cardiac toxicity .J Cardiol Cases. 2013;8:131-133
- ↑ Werder G. et al. Clenbuterol-contaminated heroin: Cardiovascular and metabolic effects. A case series and review. Conn Med. 2006; 70(1):5-11
