salbutamol induced pancreatitis

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TTBB 

Salbutamol-induced pancreatitis is extremely rare, with only a few case reports in medical literature. It is not a widely recognized or common adverse effect of salbutamol (a β2-agonist used for asthma and bronchospasm). However, when evaluating a patient with idiopathic pancreatitis, especially if they are on high doses of salbutamol, it might be considered as a diagnosis of exclusion.

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🔍 Mechanism (Theoretical/Proposed)

While not fully understood, some proposed mechanisms include:

1. Hyperstimulation of β-adrenergic receptors in the pancreas, potentially leading to:

   • Increased intracellular cAMP

   • Pancreatic enzyme secretion

   • Autodigestion/inflammation

2. Hyperglycaemia and hyperlipidaemia from β2-agonist effect, which are known risk factors for pancreatitis (although salbutamol-induced hyperlipidaemia is rare).

3. Ischaemia or microcirculatory changes in pancreatic tissue due to β2-mediated vasodilation.

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📚 Literature

• Only a few published case reports link salbutamol to acute pancreatitis, typically in the context of:

  • High-dose or prolonged nebulised/inhaled therapy

  • No other clear cause

• These are often paediatric or adolescent cases

• Most resolve after discontinuation of the drug

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🧪 Diagnosis

Salbutamol-induced pancreatitis is diagnosed by exclusion:

• Rule out common causes: gallstones, alcohol, hypertriglyceridemia, infection, trauma, medications (esp. steroids, azathioprine)

• Consider temporal association: onset after starting/increasing salbutamol

• Resolution after drug withdrawal

• Rechallenge is not recommended

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⚠️ Clinical Pearls

• Not routinely screened for — consider only when no other cause is apparent

• Amylase/lipase should be elevated in true pancreatitis (note: your patient’s amylase was 39 — within normal)

• If salbutamol is necessary, but concern remains, consider alternative bronchodilators or corticosteroid-heavy regimens with lower β-agonist use

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Summary

Salbutamol-induced pancreatitis is very rare and not a routine concern in clinical practice. Consider it only in idiopathic cases after ruling out more common causes. In your 6-year-old patient with vomiting and weight loss, salbutamol is highly unlikely to be the cause given the normal amylase and lack of pain typical of pancreatitis.

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