CASE REPORT Salbutamol intoxication: is salbutamol a drug-inducing fever? a case report and treatment strategy H.L. YILMAZ 1* , O. KUCUKOSMANOGLU 2 , H. HENNES 3 and T. CELIK 4 1 Medical Faculty of Cukurova University, Department of Emergency Medicine, Unit of Pediatric Emergency Medicine, 01330 Adana, Turkey, 2 Medical Faculty of Cukurova University, Department of Pediatrics, Section of Pediatric Cardiology, Adana, Turkey, 3 Medical College of Wisconsin, Section of Emergency Medicine, Milwaukee, USA and 4 Medical Faculty of Cukurova University, Department of Pediatrics, Adana, Turkey A four-year-old female with salbutamol intoxication was referred to our paediatric emergency medicine unit, due to agitation, tremulousness, sinus tachycardia, mild hypokalaemia and hyperglycaemia. On admission the child was agitated and had a noticeable tremor, an axillary temperature of 381C and a pulse rate of 185 beats/min. She had no identifiable focus of infection on physical examination to explain her fever. Gastric lavage, activated charcoal, intravenous hydration and electrocardiogram (ECG) monitoring were performed. Her plasma potassium level, blood sugar and QT interval were closely monitored during her hospital stay. Her fever, tachycardia and serum potassium and glucose levels returned to normal and she was discharged in good condition 24 h after admission. The difference of this case from prior cases of salbutamol intoxication was the observation of fever in the absence of evidence of infection. Since the cause of fever was not a reaction to the medication used in the treatment or related to environmental factors, it is assumed that salbutamol is a fever-inducing drug. & 2002 Lippincott Williams & Wilkins. Keywords: albuterol; child; fever; intoxication; overdose; poisoning; salbutamol INTRODUCTION Salbutamol, a synthetic sympathomimetic amine with relative selectivity for b 2 adrenergic receptors, is used widely for the treatment of acute bronchospasm. We describe a four-year-old girl who ingested large amount of salbutamol, unintentionally. A review of the pharmacology, toxicology and treatment strategy of salbutamol intoxication is discussed. CASE REPORT A four-year-old girl was referred to our paediatric emergency room from local hospital with agitation, tremulousness, sinus tachycardia and mild hypoka- laemia of 3.4 mEq/l and hyperglycaemia after she ingested half a bottle of Ventolin Syrup (150 ml salbutamol sulphate, 2 mg/5 ml) 10 h prior to trans- fer. The child first presented 3h post ingestion at the local hospital where she received gastric lavage, activated charcoal and digitalis for her tachycardia. Laboratory tests prior to transfer re- vealed a serum glucose of 352 mg/dl, and urine glucose of (+++). On arrival at our institution the child was agitated and had a noticeable tremor. Her weight was 13 kg, temperature 381C (axillary), pulse rate 185 beats/min, respiratory rate 34 beats/min and blood pre- ssure 130/70 mmHg. She had no identifiable focus of infection on physical examination to explain her fever. Laboratory test results were as follows: haemoglobin 10.4 mg/dl, haematocrit 30.4%, white blood cell count 8100/mm 3 with 72% polymorphonuclear leukocytes, 24% lymphocytes and 4% eosinophils. Plasma glucose was 130 mg/dl, blood urea nitrogen 8 mg/dl, creati- nine 0.5 mg/dl, sodium 130 mEq/l, potassium 3.1 mEq/l and lactic dehydrogenase 819 U/l. Arterial blood data were: pH 7.467, Pco 2 27.9 mmHg, HCO 3 À 19.6 mmol/l, the base excess À1.7 mmol/l, oxygen saturation (SPo 2 ) 97%. Urine analysis was *To whom correspondence should be addressed & 2002 Lippincott Williams & Wilkins EUROPEAN JOURNAL OF EMERGENCY MEDICINE, 2002, 9,179^182