CSHP Summer Educational Sessions (SES) 2013: Poster Abstracts / Séances éducatives d’été (SÉÉ) 2012 de la SCPH : Résumés des affiches
Additional Document Info
Clenbuterol is an oral ß2-agonist utilized as an illicit substance for performance-enhancement or weight loss. We report a case of clenbuterol toxicity and type II myocardial infarction after deliberate ingestion.
A 23-year-old male presented to the Emergency Department with palpitations, anxiety, chest tightness and shortness of breath after intentional ingestion of 5000 mcg of clenbuterol (125 times the recommended adult dose) to lose weight. He denied intentional self-harm or ingestion of other illicit substances. His past medical history was non-contributory. He was not taking any regular medications. On examination, he was diaphoretic and tachycardic (heart rate 160 bpm). His electrocardiogram showed sinus tachycardia with diffuse nonspecific repolarization abnormalities. Bloodwork revealed potassium of 2.0 mmol/L, lactate of 9.4 mmol/L and peak troponin of 5.39 mcg/L. He was transferred to the Coronary Care Unit for observation. Transthoracic echocardiogram was normal except for hyperdynamic left ventricular function. He was treated with intravenous fluids and oral metoprolol. His tachycardia and electrocardiogram abnormalities resolved after 48 hours. He was discharged on oral metoprolol for 1 week.
Assessment of Causality:
Probable based on the Naranjo Algorithm.
There are sporadic case reports of clenbuterol toxicity in the published literature. Clenbuterol is a long-acting, ß2-agonist indicated for the treatment of reactive airway diseases in veterinary medicine (not available in Canada for human consumption). It is more ß2-selective and 100 times more potent that salbutamol, and has purported anabolic properties. Patients often present with agitation, palpitations, tachycardia, hypokalemia and hyperglycemia. Treatment is supportive with intravenous fluids, ß-blockers and potassium supplementation.
Importance to Practitioners:
Clenbuterol has gained notoriety in recent years as a drug of abuse. Escalating societal demand for image-enhancing substances will likely lead to an increase in clenbuterol toxicity cases due to its relative attainability and readily accessible dosing information via the internet.
The dilemma of how to treat osteoporosis in patients with renal failure is an issue often faced by clinicians due to limited evidence. To provide guidance to health care providers it is important to understand their beliefs.
To describe the current practices and beliefs of pharmacists for the treatment of osteoporosis in patients with renal failure.
This was a cross-sectional survey of pharmacists working in hospitals and related healthcare settings. A 34-item online questionnaire was developed consisting of 4 sections: demographics, practice, beliefs, and comfort level. An email invitation was sent to members of CSHP (n=2499) in November 2012. Summary statistics was used for analyses.
Overall, 367 pharmacists completed the survey. Respondents were mostly female (70%), > 10 years in practice (58%), and providing care to ≥ 1 – 2 osteoporosis patients per week (58%). Forty-eight percent agreed that oral bisphosphonates can be used in patients with renal failure as long as dosage adjustments are made. Few agreed that bisphosphonates were not as effective in preventing fractures in patients with renal failure (14%), while 57% believed that adverse effects of oral bisphosphonates increased in patients with renal failure. However, there was a high “do not know” response (30%). Nearly 41% would use a bisphosphonate for creatinine clearance (CrCl) 15 – 30 mL/min, but 56% would avoid a bisphosphonate and recommend another medication for CrCl < 15 mL/min. Pharmacists expressed low level of comfort in assessing (51%) and initiating (55%) osteoporosis treatment in patients with renal failure. Most common resources identified to support practice included summary of guidelines/research (71%), tools (66%) and print continuing education material (54%).
Pharmacists had varying beliefs about approaches to managing osteoporosis in patients with renal failure. High level of interest for further learning was expressed, especially through the use of practice tools, guidelines and research summaries.