Oral Ingestion of Albuterol
Drinking albuterol causes dose-dependent cardiovascular, metabolic, and neuromuscular effects including tachycardia, tremor, hyperglycemia, and hypokalemia, but these effects are typically benign and self-limited, requiring no specific treatment in most cases.
Expected Effects and Toxicity Threshold
When albuterol is ingested orally rather than inhaled, it produces systemic beta-2 adrenergic stimulation throughout the body:
Cardiovascular Effects
- Tachycardia occurs in approximately 57% of pediatric ingestions 1
- Widened pulse pressure develops in about 50% of cases 1
- Decreased diastolic blood pressure and increased systolic blood pressure 2
- Peripheral vasodilation and decreased systemic vascular resistance 3
Metabolic Disturbances
- Hyperglycemia occurs in 50% of cases 1
- Hypokalemia develops in approximately 26% of ingestions 1
- Low serum carbon dioxide in 42% of cases 1
- Elevated serum insulin, lactate, and ketones 3
- Decreased plasma phosphate, calcium, and magnesium 3
Neuromuscular Effects
Dose-Response Relationship
The threshold dose for developing three or more signs of toxicity is 1 mg/kg, which represents 3-10 times the recommended daily therapeutic dose 1. This is a critical clinical benchmark:
- Ingestions ≤0.6 mg/kg: May be managed at home with observation alone 4
- Ingestions >0.6 mg/kg: Should receive direct medical evaluation and consideration for gastrointestinal decontamination 4
- Ingestions ≥1 mg/kg: Expect multiple signs of toxicity 1
In documented pediatric cases, ingested doses ranged from 0.2 to 8.8 mg/kg, with the most severe ingestion (6.3 mg/kg) still not requiring specific treatment beyond supportive care 1, 4.
Clinical Course and Management
Toxicity is short-lived and self-limited, with 72% of patients discharged within 6 hours of ingestion 1. The clinical approach should be:
Immediate Assessment
- Symptoms typically appear within 5-30 minutes of ingestion 2
- Peak effects occur within 30 minutes 2
- Monitor heart rate, blood pressure, and clinical appearance 1
Treatment Approach
- No specific antidote or treatment is required in the vast majority of cases 1
- Gastrointestinal decontamination may be considered for larger ingestions (>0.6 mg/kg) 4
- Supportive care and observation are sufficient 1, 4
- Hospital admission is rarely necessary 1
Common Pitfall
The most important caveat is that oral ingestion produces much more prominent systemic side effects compared to inhaled administration 3. The inhaled route causes minimal systemic effects because it achieves lower systemic drug concentrations 5, 3. When albuterol is swallowed, oral bioavailability is 10-20%, leading to higher systemic exposure 3.
Pharmacokinetic Considerations
Oral albuterol has a terminal half-life of 3-8 hours 3, explaining why symptoms resolve relatively quickly. The drug undergoes a long distribution phase before elimination 3.
While the effects can be alarming—particularly tachycardia and tremor—serious medical complications do not occur with typical accidental ingestions 1, 4. The beta-2 selectivity of albuterol means that cardiovascular effects, while present, are generally well-tolerated and self-limited 3.