Q: 54 year old male with ESRD is admitted with hyperkalemia. While hemodialysis is pending patient is administered calcium, insulin, glucose, kayexalate and albuterol. Patient went into repiratory distress requiring intubation. CXR shows no pulmonary edema and repeat labs showed potassium level in normal range of 4.8 mEq/L. Physical exam shows severe wheezing?



Answer: Paradoxical bronchospasm to albuterol

Paradoxical bronchospasm is a rare complication of albuterol therapy. The true mechanism of the phenomenon is unknown.Confirmed diagnosis based on rechallenge.

Raghunathan K, Nagajothi N., Paradoxical bronchospasm: a potentially life threatening adverse effect of albuterol., South Med J.2006 Mar;99(3):288-9.