Albuterol Inhalant Exposure in Dogs

In the Literature

Meroni ER, Khorzad R, Bracker K, Sinnott-Stutzman V. Retrospective evaluation of albuterol inhalant exposure in dogs: 36 cases (2007-2017). J Vet Emerg Crit Care (San Antonio). 2021;31(1):86-93.

The Research …

Albuterol is a selective beta₂-adrenergic–receptor agonist commonly used as a bronchodilator in patients with obstructive pulmonary diseases and can be prescribed in metered-dose inhalers that allow absorption of the drug directly into the lungs. 

Dogs can be exposed to albuterol when they chew on an inhaler and the albuterol is either inhaled or directly ingested. Clinical signs of albuterol toxicosis vary and result from activation of beta-adrenergic receptors throughout the body. Case reports that describe treatment and outcome in dogs following albuterol toxicosis are limited.^1-4 

This retrospective study aimed to report clinical signs, laboratory abnormalities, treatments, and outcomes in dogs presented for albuterol toxicosis. The study also aimed to determine whether hypokalemia was common and correlated with severity of clinical signs. 

The study included 36 dogs presented for suspected albuterol exposure over a 10-year period. Documented physical examination findings included heart rate and rhythm, respiratory rate, body temperature, and blood pressure. Recorded laboratory values included electrolytes, blood glucose, plasma lactate, BUN, and creatinine. Tachycardia (94%) and tachypnea (67%) were the most commonly identified clinical abnormalities. Hypokalemia and hyperglycemia were present on admission blood work in 69% and 67% of the dogs, respectively. 

Twenty-seven of the 36 dogs were hospitalized and received IV fluids (96%), IV or oral potassium supplementation (89%), and/or IV or oral beta-adrenergic antagonists (70%). Dogs with potassium <3.2 mmol/L on admission were 14 times more likely than those with higher potassium levels to have persistent tachycardia (heart rate, >180 bpm) that required treatment with propranolol (one dog also received esmolol due to unresponsiveness to propanolol). Nine dogs were treated on an outpatient basis; 4 received treatment that included subcutaneous fluids, oral potassium supplementation, and oral beta-blockers, and 5 did not receive any treatment. 

This study demonstrates that dogs treated for albuterol toxicosis have an excellent prognosis, and hospital duration, if required, is typically <24 hours. More severe toxicoses may be identifiable via potassium values on presentation; future studies are warranted.

… The Takeaways

Key pearls to put into practice:

• Albuterol toxicosis occurs in dogs after ingestion or inhalation via exposure to metered-dose inhalers. Common clinical and laboratory findings include tachycardia, tachypnea, hypokalemia, and hyperglycemia.

• Treatment for albuterol toxicosis is supportive and includes fluid administration, electrolyte supplementation, and cardiovascular monitoring. Severe toxicosis may require medications (eg, beta-blockers) that lower the heart rate. Prognosis is excellent with treatment.

• Potassium level on admission may help distinguish dogs with severe toxicosis from dogs with less severe toxicosis. Dogs with potassium levels <3.2 mmol/L are considered more severely affected and are more likely to require treatment with a beta-blocker.