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.


 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.