SALBUTAMOL/ TURBUTALINE
Salbutamol is a selective beta-2 receptor agonist. It is widely used for reversible airway obstruction to relieve bronchospasm. It is also used in obstetrics to prevent the progress of premature labour.
Clinical features
Anorexia, nausea, vomiting, abdominal pain and diarrhoea are the features of poisoning. Cardiac effects include tachycardia, initial hypertension followed by hypotension and angina. It may give rise to supraventricular and ventricular ectopics. Exaggerated reflexes, tremors, dilated pupils, agitation, seizures, coma, metabolic disturbances including hyperglycaemia, hypokalaemia and hypomagnesaemia may be observed.
Salbutamol suggested toxic dose 0.7 mg/kg
terbutaline suggested toxic dose 1 mg/kg
Serious toxicity is unlikely after inhalation.
Ingestions of doses less than 1 mg/kg in children are unlikely to result in severe toxicity (Wiley et al, 1994; Spiller et al, 1993).
Management
Ingestion
- Maintain an open airway and assited ventilation if necessary.
- Monitor the vital signs and symptoms and take an ECG 4-6 hours after ingestion.
- Give Oxygen, check blood glucose, U&Es and ABG. FBC, LFT, Mg, Phosphate and CK. Correct acid base and metabolic disturbances.
- Diazepam 5 to 10mg IV and repeat if necessary it convulsion present.
- Gastric decontamination with activated charcoal if the patient presents within 2 hour of ingestion of a toxic dose. Multiple dose activated charcoal is recommended.
- Monitor pulse, BP, respiratory rate, temperature and cardiac rhythm.
- Adequate oral or IV fluids. Maintain fluid balance chart. Beware severe hyperkalaemia.
- Correct hypoglycaemia as quickly as possible.
Hypotension
Adequate fluid resuscitation with a crystalloid. Treat brady and tachyarrhythmias appropriately.
Metabolic acidosis
If metabolic acidosis persists despite correction of hypoxia and adequate fluid resuscitation, consider intravenous Sodium bicarbonate. Haemodialysis – If acute renal failure or severe hyperkalaemia.
Agitation and Delirium
Adults
Oral or IV diazepam (0.1-0.3 mg/kg body weight) is recommended. Further boluses, given IV, may be administered if the patient remains severely agitated 10 to 15 minutes after the initial bolus, provided there is no impairment of respiratory function.
Children
It is better to be managed agitation without sedation and exclude other causes (e.g. hypoxia, infection, hypoglycaemia and raised ICP). Consider nursing in a dark and quiet environment with a close relative. S