Bezeljak Neva, Jerman Alexander, Grenc Damjan, Krzisnik Zorman Simona
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Case Rep Nephrol Dial. 2024 Jun 18;14(1):88-96. doi: 10.1159/000536523. eCollection 2024 Jan-Dec.
Salbutamol is a moderately selective beta-2-adrenergic agonist. Various side effects can occur because of beta-1 and beta-2 receptor activation. Due to the large volume of distribution, it is not considered dialyzable.
A patient with salbutamol intoxication, which developed as a result of a medical error in a patient with sepsis, Down syndrome, and liver cirrhosis, is presented. Initial treatment was partially successful and antibiotic adjustments were made. After his respiratory failure worsened, the patient needed non-invasive ventilation, and previously undiagnosed chronic obstructive pulmonary disease was suspected. He was prescribed intravenous methylprednisolone but accidently received 5 mg of salbutamol (albuterol), which led to immediate severe arrhythmic tachycardia with hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was commenced to decrease suspectedly highly elevated serum salbutamol levels. After 30 min, sinus rhythm with normocardia was observed. After the hemodialysis termination, no rebound tachycardia was noted, but due to severe septic shock, the hypotension was ongoing and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol and data from literature do not support the view that hemodialysis was the cause of the described improvement: the total amount of the drug cleared was very small (2.8% of total dose).
Our results confirm a large volume of salbutamol distribution; the measured levels are within observed therapeutic levels; and the measured half-life time during hemodialysis (3.1 h) is comparable to observed half-life times in therapeutic settings. The observed favorable clinical benefit associated with dialysis may be fortuitous, highlighting potential bias toward positive clinical outcomes and unproven ("salvage") therapies.
沙丁胺醇是一种中度选择性β2肾上腺素能激动剂。由于β1和β2受体激活，可能会出现各种副作用。因其分布容积大，故不认为可通过透析清除。
本文介绍了一名因医疗差错导致沙丁胺醇中毒的患者，该患者患有败血症、唐氏综合征和肝硬化。初始治疗部分成功，并进行了抗生素调整。在其呼吸衰竭恶化后，患者需要无创通气，怀疑患有先前未诊断出的慢性阻塞性肺疾病。他被处方静脉注射甲泼尼龙，但意外接受了5mg沙丁胺醇（舒喘宁），这立即导致严重的心律失常性心动过速并伴有血流动力学崩溃。在心脏复律失败并用兰地洛尔输注治疗后，开始进行挽救性血液透析以降低疑似高度升高的血清沙丁胺醇水平。30分钟后，观察到窦性心律且心率正常。血液透析结束后，未观察到反弹性心动过速，但由于严重的感染性休克，低血压持续存在，因此调整了血管活性药物。然而，所测得的血浆沙丁胺醇水平及文献数据并不支持血液透析是所述改善原因的观点：清除的药物总量非常少（占总剂量的2.8%）。
我们的结果证实了沙丁胺醇分布容积大；所测水平在观察到的治疗水平范围内；血液透析期间测得的半衰期（3.1小时）与治疗环境中观察到的半衰期相当。观察到的与透析相关的良好临床益处可能是偶然的，这突出了对积极临床结果和未经证实的（“挽救性”）疗法存在潜在偏倚。
