CLENBUTEROL POISONING - CLINICAL MANIFEST ATIONS AND ANALYTICAL FINDINGS IN AN EPIDEMIC OUTBREAK IN MOSTOLES, MADRID

Objective. To report the clinical manifestations and analytical findin gs in an epidemic outbreak of acute food poisoning with clenbuterol. M aterials and methods. The clinical manifestations, physical examinatio n findings and results of complementary tests are reported of fifteen patients performed by veal liver contaminated with clenbuterol. The cl inical course of patients at 72 hours is reported. A quantitative meas urement of clenbuterol in urine specimens from patients and in a veal liver specimen was performed by high pressure liquid chromatography (H PLC). Results. The male/female distribution of patients was 7/8 respec tively, with age ranging from 6 to 44 years. Symptoms appeared after 3 0 minutes to 2 hours of having ingested veal liver in 93% of cases. Pa tients presented at the Emergency Department wlith tremors, palpitatio ns, anxiety, malaise, nausea, and pruritus as the most common complain ts. On physical examination tachycardia was noted in 100% of cases. Th e analytical data included mild hypokaliemia (66%) and leukocytosis (2 8%). Only one patient required hospital admission on account of an hyp ertensive crisis. After 72 hours, 67% of patients were asymptomatic. T he remaining patients had mild symptoms which included headache, myalg ia, asthenia and anorexia. Serum potassium values returned to normalit y (p < 0,05). Urine measurements of clenbuterol were positive for all analysed cases (50 +/- 42 ng/ml). The concentration of clenbuterol in a veal liver sample was 500 ppb.Conclusion. Clenbuterol poisoning shou ld be suspected when symptoms of adrenergic hyperstimulation occur aft er the ingestion of meal, usually liver. Common symptoms include tachy cardia and mild hypopotasemia. Diagnosis is confirmed by quantitative measurement of clenbuterol in urine. Most patients improve spontaneous ly shortly afterwards.