Clinical Practice and Cases in Emergency Medicine

Clenbuterol is a beta-agonist that has been abused by fitness-oriented individuals for muscle growthand weight loss. We report a case of a 46-year-old man who presented tachycardic, hypokalemic, andhyperglycemic after injecting testosterone obtained from Brazil. He developed refractory hypotensionand was started on an esmolol infusion for suspected beta-agonist toxicity. Laboratory analysisshowed a detectable clenbuterol serum concentration. Analysis of an unopened ampule containedboldenone undecylenate, clenbuterol, and vitamin E. This case illustrates a novel exposure thatcaused beta-agonist toxicity and was treated successfully with rapid-onset beta blocker.