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Clenbuterol toxicity in a young male athlete

Abstract Clenbuterol is a long-acting β-agonist that has several pharmacologic actions. In the past, it was misused mainly by bodybuilders and athletes to enhance their performances due to its lipolytic and muscle-enhancing effects. Today, its use has spread among recreation athletes as a weight loss agent. Since toxicity following clenbuterol is a rarely reported syndrome, we present a case of acute toxicity resulting in symptoms of sympathetic activation with haemodynamic instability and ECG signs of myocardial damage. A 34-years-old male, active local football player with no previous medical history, presented at our Emergency Unit with severe chest pain and shortness of breath. He was agitated, tachycardic and hypotensive, there were signs of myocardial damage on ECG. On admission, cardiac enzyme levels were normal [Troponin-T (TnT) 0.02 mcg/l] but started to rise soon afterwards (TnT 0.145 mcg/l), hypotension persisted and pain was worsening. The patient was managed with supportive care, he was given fluids, morphine, midazolam, sodium bicarbonate and vasopressor support. No invasive procedures were needed. He was discharged painless, with normal ECG and laboratory tests after 4 days. As abuse of weight loosing agents and anabolic substances is spreading rapidly, it should be always considered in young patients presenting with sympathomimetic features.