Daubert G Patrick, Mabasa Vincent H, Leung Vivian W Y, Aaron Cynthia
Department of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, CA 95817, USA.
J Med Toxicol. 2007 Jun;3(2):56-60. doi: 10.1007/BF03160909.
We are presenting a case illustrating the complex metabolic and rhythm disturbances associated with acute clenbuterol intoxication.
Clenbuterol is a long-acting beta2-adrenergic agonist primarily used in veterinary medicine in the United States. It has become a common drug of abuse by body builders because of its reported anabolic and lipolytic properties. In this case report, a body builder using veterinary clenbuterol developed significant electrolyte and cardiac manifestations.
A 31-year-old man presented to the emergency department approximately 30 minutes after ingesting 1.5 ml (a tenfold dosing error) of Ventipulmin syrup (72.5 mcg/ml clenbuterol HCl). The product was brought to the emergency department (ED) by the patient. He reported no current use of anabolic steroids. He presented in an anxious state with complaints of palpitations and shortness of breath. Vital signs upon examination were as follows: BP, 122/77 mmHg (16.3/10.3 kPa); HR 254 bpm; RR, 22 bpm; Temperature, 97.1 degrees F (36 degrees C); and oxygen saturation, 100% on ambient air. His electrocardiogram (ECG) demonstrated supraventricular tachycardia with a ventricular rate of 254 bpm. Esmolol was recommended for rate control after the unsuccessful use of adenosine and diltiazem. Laboratory studies showed potassium, 2.1 mmol/L; magnesium, 1.3 mg/dL (0.54 mmol/L); phosphorus, 1.0 mg/dL (0.32 mmol/L); serum glucose, 209 mg/dL (11.6 mmol/L); creatinine, 0.8 mg/dL (70.7 micromol/L); AST, 20 U/L; ALT, 55 U/L; hemoglobin, 12.6 g/dL (126 g/L); CPK total, 87 U/L; and troponin I, 0.23 mug/L. The patient's urine was negative for any drugs of abuse. Clenbuterol levels were not obtained. A second ECG, 16 hours post ingestion, reflected atrial fibrillation with a ventricular rate of 125 to 147 bpm. On hospital day 3, he was electively cardioverted to sinus rhythm; heart rate and rhythm returned to normal, and he was discharged with oral metoprolol.
Clenbuterol is approved for use in countries outside the U.S. as a bronchodilator for the treatment of acute asthma exacerbations in humans. Although clenbuterol is not a steroid hormone, it possesses anabolic properties that increase muscle mass. Its longer duration of action compared to other beta2-agonists (such as albuterol) make it a desired agent for body-building because of its high and prolonged serum level. The mechanism for the short and long-term cardiovascular complications of clenbuterol is complex. The anabolic effects of clenbuterol are associated with its beta2-adrenoreceptor agonist activity on striated skeletal muscles. In addition, clenbuterol promotes lipolysis through adipocyte beta3-adrenoreceptors.
Considering the significant number of body-building enthusiasts, physicians will continue to encounter clenbuterol abuse in their clinical practices.
我们报告一例病例，以说明急性克仑特罗中毒相关的复杂代谢和节律紊乱。
克仑特罗是一种长效β2肾上腺素能激动剂，在美国主要用于兽医学。由于其具有合成代谢和脂肪分解特性，它已成为健身者常用的滥用药物。在本病例报告中，一名使用兽用克仑特罗的健身者出现了明显的电解质和心脏表现。
一名31岁男性在误服1.5毫升（剂量错误10倍）的Ventipulmin糖浆（72.5微克/毫升盐酸克仑特罗）后约30分钟被送往急诊科。该产品由患者带到急诊科。他报告目前未使用合成代谢类固醇。他因心悸和呼吸急促而焦虑不安。检查时的生命体征如下：血压，122/77毫米汞柱（16.3/10.3千帕）；心率254次/分；呼吸频率，22次/分；体温，97.1华氏度（36摄氏度）；在室内空气中的氧饱和度为100%。他的心电图（ECG）显示室上性心动过速，心室率为254次/分。在使用腺苷和地尔硫卓未能成功控制心率后，建议使用艾司洛尔进行心率控制。实验室检查显示钾，2.1毫摩尔/升；镁，1.3毫克/分升（0.54毫摩尔/升）；磷，1.0毫克/分升（0.32毫摩尔/升）；血清葡萄糖，209毫克/分升（11.6毫摩尔/升）；肌酐，0.8毫克/分升（70.7微摩尔/升）；谷草转氨酶，20单位/升；谷丙转氨酶，55单位/升；血红蛋白，12.6克/分升（126克/升）；肌酸磷酸激酶总量，87单位/升；肌钙蛋白I，0.23微克/升。患者尿液中未检测出任何滥用药物。未检测克仑特罗水平。摄入后16小时的第二次心电图显示房颤，心室率为125至147次/分。在住院第3天，他被择期转复为窦性心律；心率和节律恢复正常，他出院时服用口服美托洛尔。
克仑特罗在美国境外被批准作为支气管扩张剂用于治疗人类急性哮喘发作。虽然克仑特罗不是类固醇激素，但它具有增加肌肉量的合成代谢特性。与其他β2激动剂（如沙丁胺醇）相比，其作用持续时间更长，由于其血清水平高且持续时间长，使其成为健身的理想药物。克仑特罗短期和长期心血管并发症的机制很复杂。克仑特罗的合成代谢作用与其对横纹肌的β2肾上腺素能受体激动活性有关。此外，克仑特罗通过脂肪细胞β3肾上腺素能受体促进脂肪分解。
考虑到健身爱好者数量众多，医生在临床实践中仍会不断遇到克仑特罗滥用的情况。
