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The ambulance was called to a known asthmatic patient. On arrival, the team found a massively dyspnoeic, diaphoretic, non-cyanotic and somnolent patient. His medication consisted of oral theophylline (unknown dosage), fenoterol (metered-dose inhaler), as well as 8 mg oral prednisolone. On the day of emergency, the patient had been treated by two physicians who applied two doses of i.v. theophylline and one dose of s.c. terbutaline because of bronchoconstriction (dosage not documented). The patient's pulse was frequent with 200 beats/min, the blood pressure not measurable. Careful i.v. titration of metoprolol was started to decrease the patient's heart rate and increase diastolic filling and stroke volume. However, the patient showed a progressive circulatory collapse. Following diagnostic thoracocentesis to rule out a left-side pneumothorax, the patient required intubation and mechanical ventilation because of increasing cardiovascular instability. A tension pneumothorax developed immediately after mechanical ventilation and required rapid treatment with a chest tube. Nevertheless, CPR and intravenous infusion of catecholamines were necessary before the patient was referred to a medical intensive care unit where he died the same day in cardiogenic shock. Clinical signs and symptoms associated with an elevated theophylline plasma level make theophylline toxicity the probable causative event for the patient's emergency condition of acute theophylline intoxication.

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A 2-year-old Collie-type dog with lethargy, tachycardia, tachypnea, and muscle tremors was examined 10 hours after the dog had bitten into an inhalation canister containing the beta 2-adrenergic agonist, terbutaline sulfate. Electrocardiographic findings (ventricular premature contractions and paroxysmal ventricular tachycardia) were consistent with excessive adrenergic activity resulting from terbutaline toxicosis. Serum terbutaline concentration was similar to that reported in human beings with terbutaline toxicosis. The dog did not respond to initial treatment with fluids and lidocaine administered IV, but rapid resolution of signs and conversion to normal sinus rhythm was achieved after IV infusion of propranolol.

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A multidimensional column chromatographic method involving electrochemical detection using a carbon fibre microelectrode flow cell was optimized and successfully applied to the simultaneous determination of salbutamol and terbutaline in plasma at overdose levels. This method performs, in a single step, an efficient extraction and clean-up of salbutamol and terbutaline from human plasma. The calibration graphs over three days were linear over the calibration range 20-100 ng/mL plasma with a limit of detection of 1 ng and 0.8 ng/mL plasma for salbutamol and terbutaline, respectively. The intra- and inter-assay coefficients of variation were less than 8% and the recoveries ranged from 94 to 96%. The accuracy of the assay, which was defined as the percentage difference between the mean concentration found and the theoretical concentration, was 7% or better. The proposed method combines the advantages of being simple, reproducible and selective in the presence of other sympathomimetic and commonly ingested drugs and is suitable for routine analyses to obtain valuable information about the clinical effects and treatment of overdose with these drugs. The whole procedure takes ca. 10 min and compares favourably with detection at a conventional glassy carbon electrode.

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A case of rhabdomyolysis-induced acute renal failure secondary to overdosage with the beta 2-adrenoceptor agonist terbutaline is described. This is a previously undocumented association. We propose that the hyperkinetic effects of intense beta-receptor stimulation may induce rhabdomyolysis.

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A young female patient was admitted twice within two months, each time after an overdose of 500 mg terbutaline. Clinical features included nausea, tachycardia, tremor, hyperglycemia and hypokalemia. Although plasma concentrations of terbutaline were at least 50 times the normal therapeutic level, after potassium substitution the outcome was uneventful.

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A method has been developed for the simultaneous determination of the sympathomimetic drugs salbutamol and terbutaline in the plasma of poisoned patients, using ion-pair high-performance liquid chromatography with amperometric detection. Plasma concentrations of the drugs, measured in 8 poisoned patients, were well above the therapeutic range. The clinical and metabolic effects of overdose with these drugs were considerably less severe than those seen in patients with plasma theophylline concentrations elevated to the same degree.

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