Albuterol causing hyperglycemia?

[pinipig523]

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So I had this patient who I gave several rounds of nebs - about 5 in 4 hours. We ended up admitting the patient because of lack of improvement. We drew basic labs and a vbg.

The glucose came back 359, in a not previously dx diabetic patient.

My question is - I've been doing this ER residency thing for my 4th year now, but I don't really recall hyperglycemia to this level from repeated albuterol dosing before.

I know hyperglycemia can be caused by albuterol overdose but have any of you guys noted a marked hyperglycemic reaction to several rounds of nebs?

Thanks!

 

[Venko]

So I had this patient who I gave several rounds of nebs - about 5 in 4 hours. We ended up admitting the patient because of lack of improvement. We drew basic labs and a vbg.

The glucose came back 359, in a not previously dx diabetic patient.

My question is - I've been doing this ER residency thing for my 4th year now, but I don't really recall hyperglycemia to this level from repeated albuterol dosing before.

I know hyperglycemia can be caused by albuterol overdose but have any of you guys noted a marked hyperglycemic reaction to several rounds of nebs?

Thanks!

Was the patient acidotic? Could it be that the dyspnea which was unresponsive to albuterol was from new DKA / HHS spectrum disorder? I'm sure you thought of this, but I thought I would just check.

 

[la gringa]

or was it the steroids you gave him that unmasked an undx diabetic?

 

[southerndoc]

Beta-2 agonism causes glycogenolysis and gluconeogenesis. So yes, albuterol will raise your glucose levels, especailly in large doses.

As someone else has mentioned, steroids will also do the same (although it's usually more delayed).

 

[doctorFred]

Was the patient acidotic? Could it be that the dyspnea which was unresponsive to albuterol was from new DKA / HHS spectrum disorder? I'm sure you thought of this, but I thought I would just check.

i've seen pretty significant tachypnea from DKA, but dyspnea? i feel like often times, those DKA'ers feel comfortable breathing in the 30s.

 

[roja]

And I would say, as you didn't have a fingerstick or glucose LEVEL before you started the albuterol, there is no way to know if ANYTHING caused the elevated glucose level or if it was there before hand. Its possibly the pt had been sitting around for weeks wiht an elevated glucose and the albuterol 'unmasked' it by causing you to send a glucose level.

Interesting intellectual exercise though.

 

[Venko]

i've seen pretty significant tachypnea from DKA, but dyspnea? i feel like often times, those DKA'ers feel comfortable breathing in the 30s.

Ive had many complain of dyspnea. Ive never been acidotic like that so I cant speak from my personal experience other than as a practitioner.

All the other comments are great considerations too.