Case Report Supraventricular Tachycardia in a Child with Williams Syndrome after Nebulized Albuterol Urgent message: Clinicians must be prepared for the possibility of supraventricular tachycardia after administration of nebulized albuterol in patients of any age, especially in the presence of heart disease. Muhammad Waseem, MD, Padma Gadde, MD, and Gerard Devas, MD Introduction sthma is the most common lung disease in children. Five percent of children in the United States have asthma, and status asthmaticus—the leading cause of admission due to asthma exacerbation—accounts for approximately 10% of visits to pediatric emer- gency departments. 1 Here, we present a case involving a 2-year-old asth- matic boy with Williams syndrome (WS) who developed supraventricular tachycardia (SVT) following standard administration of albuterol. This case report emphasizes the need for increased awareness among urgent care and emergency physi- cians, and describes the use of adenosine in the treat- ment of SVT due to ␤ 2 agonist albuterol. A In the emergency department, he was in moderate res- piratory distress with a temperature of 102.3 ° F, respirato- ry rate of 34 breaths per minute, heart rate of 169 beats per minute, and oxygen saturation of 95%. He had coarse breath sounds with wheezing. Cardiac examination revealed a regular rate and rhythm and no murmur. The boy was brought to an asthma room because of his respiratory distress and wheezing and started on nebulized albuterol. A chest radiograph revealed right upper lobe pneumonia. The heart size and pulmonary vascularity were normal. The patient was placed on a pulse oximeter. The following were noted: Ⅲ Three episodes of vomiting during second nebuliz- er treatment Ⅲ Heart rate of 242 beats per minute Case A 2-year-old boy with WS presented to the emergency department with a three-day history of fever, cough, and wheezing. He received three doses of nebulized albuterol and was diagnosed with reactive airway disease and bilateral otitis media. He was discharged on oral amox- icillin and prednisolone and albuterol MDI. The patient returned to the emergency department two days later with similar symptoms and vomiting. He had been receiving albuterol MDI every six hours for the previous two days. His parents reported that he vomit- ed shortly after receiving albuterol. Previously, he had one episode of pneumonia that improved with oral antibiotics. 22 Figure 1 JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | O c t o b e r 2 0 0 7 w w w. j u c m . c o m