Tester Andrew A, Logan Sheena, Pollock Louisa, McKie Allison
Emergency Department, Royal Hospital for Children, Glasgow, Scotland, UK
Emergency Department, Royal Hospital for Children, Glasgow, Scotland, UK.
BMJ Case Rep. 2020 Mar 12;13(3):e233180. doi: 10.1136/bcr-2019-233180.
A 13-year-old girl presented to the emergency department with acute onset of chest pain, nausea and tremor. The patient denied drug ingestion, and urine toxicology was negative. ECG demonstrated sinus tachycardia, prolonged QTc (541 ms) and ST depression. Laboratory testing demonstrated metabolic acidosis, hypokalaemia, hypophosphataemia and hyperglycaemia. She was commenced on continuous cardiac monitoring and treated with intravenous fluids and electrolyte replacement. Presenting features and laboratory abnormalities resolved within 48 hours. The National Poisons Information Service and Clinical Biochemistry were integral to her management, advising the clinical team on the likeliest aetiology. Five weeks after discharge, urine toxicology, using mass spectrometry, identified clenbuterol. Clenbuterol is an oral β2-agonist with anabolic and lipolytic effects that is misused as a performance and image enhancing drug. Clinicians must be aware of the increasing availability of these drugs and their potential for causing harm in children and adolescents.
一名13岁女孩因突发胸痛、恶心和震颤被送往急诊科。患者否认服用药物，尿液毒理学检查呈阴性。心电图显示窦性心动过速、QTc延长（541毫秒）和ST段压低。实验室检查显示代谢性酸中毒、低钾血症、低磷血症和高血糖症。她开始接受持续心脏监测，并接受静脉输液和电解质补充治疗。症状和实验室异常在48小时内得到缓解。国家毒物信息服务中心和临床生物化学对她的治疗起到了重要作用，为临床团队提供了最可能病因的建议。出院五周后，采用质谱法进行的尿液毒理学检查发现了克伦特罗。克伦特罗是一种口服β2激动剂，具有合成代谢和脂肪分解作用，被滥用为提高成绩和改善形象的药物。临床医生必须意识到这些药物越来越容易获得，以及它们对儿童和青少年造成伤害的可能性。
