Can accidental oral ingestion of albuterol cause vomiting?

Can Accidental Oral Ingestion of Albuterol Cause Vomiting?

Yes, accidental oral ingestion of albuterol can cause vomiting, though it occurs in only about 26% of pediatric overdose cases and is generally a benign, self-limited symptom that does not require specific treatment. 1

Incidence and Clinical Significance

• Vomiting is reported in approximately 26% (20/78) of children who accidentally ingest albuterol and receive urgent medical evaluation 1
• In a separate two-year retrospective study, only 2 children experienced brief nausea and vomiting among those followed at home, representing a very small fraction of exposures 2
• The FDA drug label for oral albuterol lists vomiting in 2-4% of patients receiving therapeutic doses, confirming it as a recognized adverse effect 3

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 dose 1
• For ingestions of 0.6 mg/kg or less, treatment at home with observation may be sufficient, as serious symptoms are unlikely 2
• Vomiting typically occurs alongside other sympathomimetic effects including tachycardia (57%), agitation (45%), and widened pulse pressure (50%) 1

Expected Clinical Course

• Toxicity is short-lived and does not require specific therapy or hospital admission in most cases 1
• Approximately 72% of patients are discharged within 6 hours of ingestion, indicating rapid resolution of symptoms 1
• No serious medical complications or deaths have been reported in pediatric case series of unintentional albuterol ingestion 1, 2

Management Approach

• For ingestions greater than 0.6 mg/kg, consider direct medical evaluation and gastrointestinal decontamination 2
• Activated charcoal and intravenous hydration may be administered in the emergency department for larger ingestions 4
• Observation for 4-6 hours is typically adequate, as most cardiovascular effects (tachycardia) resolve within this timeframe 4
• No specific antidote or treatment is required for vomiting related to albuterol overdose 1

Key Pitfall to Avoid

• Do not assume vomiting alone indicates severe toxicity—it is a common but benign manifestation that occurs even with modest overdoses 1, 2
• The presence of vomiting does not predict need for hospitalization or intensive intervention in the absence of other concerning signs 1