Hypokalemia after pediatric albuterol overdose: a case series

Sympathomimetic use results in a triad of hypokalemia, hyperglycemia, and elevated white blood cell count. Transient hypokalemia results from activation of the Na+/K+ pump and transport of potassium intracellularly. Increased serum glucose and insulin may also contribute to the intracellular shift of potassium after sympathomimetic use. Four cases of accidental pediatric albuterol ingestion with significant hypokalemia are reported. Four children between 1 and 6 years of age presented to the emergency department within 5 hours of ingesting 3.0, 1.1, 3.7, and 1.7 mg/kg albuterol, respectively. All four presented alert and oriented in no apparent distress. The most common findings were vomiting, sinus tachycardia, and hypokalemia (2.3, 2.5, 2.8, and 2.5 mmol/L, respectively). Each child received a single dose of activated charcoal and intravenous potassium replacement. All patients recovered uneventfully within 12 to 24 hours with supportive care only. These cases demonstrated that significant depressions in serum potassium can occur after pediatric albuterol overdose. Although transient, the dose-response relationship and duration of effect is unknown. Although significant hypokalemia can occur after ingestion of oral sympathomimetics, replacement should be managed on an individual basis until further studies are completed.