toxicology

Q: 32 year old male presented to ED after new year Friday night party with chest pain and hypertension. He admits using Cocaine. Initial labs showed hypokalemia of 2.9 mEq/L. What would be your concern? 


Answer: Clenbuterol 

 Clenbuterol is an adulterant frequently found in cocaine and heroin. Clenbuterol tends to cause a tetrad of 

•  tachycardia 
•  hyperglycemia
•  palpitations, and 
•  hypokalemia 

Also, it may cause nausea, hypo or hypertension, thyrotoxicosis, chest pain, venous hyperoxia but with lactic acidosis, central symptoms of agitation and anxiety. Treatment is supportive. 

#toxicology


 Reference: 

 Centers for Disease Control and Prevention (CDC). Atypical reactions associated with heroin use--five states, January-April 2005. MMWR Morb Mortal Wkly Rep 2005; 54:793.