Salbutamol - intoxication

Part I

A 2-year-old boy accidentally ingested salbutamol sulfate inhalant (Ventolin inhalant; 0.5%, 30
mL/bottle) prescribed for the patient’s elder brother. Mother happened to witness the accident and
immediately brought the patient to a nearby physician. The ingested volume of the inhalant was
estimated to be 15 mL.

1. To which drugs class belongs salbutamol sulfate - what is its mechanism of action, in which
indication is it used?


2. How are the selective β[2] adrenergic agonists classified? Give representatives.


3. Which other groups of drugs are used as bronchodilators? What are their mechanisms of action?


Part II

Overdose of salbutamol sulfate and other β[2 ]selective bronchodilators involves unwanted
sympathomimetic effects, including cardial β[1] receptors activation, peripheral vasodilatation,
muscle cramps, hyperglycemia, and hypokalemia.

Sinus tachycardia develops due in part to a decrease in peripheral resistance associated with a
reflex increase in cardiac output.

5. How would you solve the situation? Suggest a suitable pharmacotherapy.


Part III

Treatment is primarily aimed at eliminating the ingested β[2 ]agonist by means of gastric lavage,
diuresis and induction of laxation, and if necessary, a cardio-selective β blocker such as
metroprolol may be given by injection. Non-selective β blockers are contraindicated for asthma. It
is recommended to monitor the serum potassium and glucose levels for possible hypokalemia and
hyperglycemia, and to secure fluid infusion route. More important than the consequence and
treatment of accidental β[2 ]agonist inhalant ingestion is the means of its prevention.

6. Suggest how would you educate parents - including recommended preventive measures or warning,
how to behave in case of repetition of the situation.








Part IV

It is recommended that families with infants and pre-school age children should keep the inhalant
essentially inaccessible to children by storing the drug in a tightly capped container, on a high
place or even in a locker.

The form of drug container also needs to be considered – small containers are safer.

In case of accidental indigestion: The patient should not be made to throw up, because it would
result in loss of fluid and electrolytes and aggravate the condition. Therefore, it is best for
family members to bring the patient to a physician’s care immediately.