ABSTRACT

Two-months-old girl was admitted with the diagnosis of acute bronchiolitis due to respiratory syncytial virus. The chest x-ray findings were consistent with acute bronchiolitis and there was no cardiomegaly. The patient was treated with oral albuterol one day before hospital admission. Nebulized albuterol, nebulized 3% NaCl, and intravenous fluid therapy were administered after hospitalization. After the first dose of nebulized albuterol, a sudden tachycardia, with a heart rate up to 280 beats per minute was observed. Electrocardiogram revealed lack of P-waves, and normal duration (< 0.09 seconds) of QRS, suggesting supraventricular tachycardia. Ice was applied to the face to induce vagal stimulus. Then adenosine (100 µg/kg) was administered by intravenous route due to unresolved tachycardia. Her heart rate decreased to 160 beat per minute after adenosine was applied. Although albuterol therapy was discontinued, supraventricular tachycardia repeated two-times with intervals of six hours during the follow-up. The second attack was relieved with vagal maneuver however the third episode was relieved with adenosine administration. There was no abnormal finding on echocardiograhy. Propranolol was started as a prophylaxis to prevent relapse of supraventricular tachycardia. This patient was presented as supraventricular tachycardia, which was triggered by albuterol.

Keywords: albuterol, bronchiolitis, respiratory syncytial virus, supraventricular tachycardia