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ANGELA BOORD, PHARM.d ., CDE, is Education Pharmacist, and BRIAN BENSON, PHARM.d ., is Pharmacy Manager, Iowa Lutheran Hospital Pharmacy, Des Moines.

Address correspondence to Dr. Boord at Iowa Lutheran Hospital Pharmacy, 700 E. University, Des Moines, IA 50316 (boordas{at}ihs.org).

Purpose. The occurrence of myoclonus associated with continuous i.v. infusion of dobutamine in a patient with end-stage renal disease (ESRD) is described. Summary. A 65-year-old Caucasian man was admitted to the hospital on January 26, 2006, for worsening congestive heart failure (CHF). He had been receiving dobutamine 3 µg/kg/min by intermittent i.v. infusion over four hours once weekly as an outpatient. His medical history included ischemic cardiomyopathy, pacemaker placement, ESRD, carotid artery disease, and type 2 diabetes mellitus. Along with receiving multiple other drugs, the patient was started on a continuous i.v. infusion of dobutamine 3 µg/kg/min. On January 29, the patient began having myoclonic muscle spasms. Clonazepam was given as needed, and the patient was discharged on February 1 with myoclonus that soon subsided. On March 13 the patient was again admitted for worsening CHF and was started on continuous dobutamine infusion. He was discharged on March 15; myoclonic muscle spasms began that afternoon. Myoclonic movements were noted when the patient arrived at the outpatient infusion center to begin his intermittent dobutamine infusion, and he was sent to the emergency department, where he was treated with calcium gluconate, regular insulin, and lorazepam and was instructed to stop his potassium supplements; he then received his dobutamine infusion. The myoclonic symptoms continued until March 18, when they subsided. Conclusion. A patient with CHF and ESRD developed myoclonic muscle spasms after receiving dobutamine by continuous i.v. infusion. Index terms: Anticonvulsants; Calcium gluconate; Clonazepam; Dobutamine; Heart failure; Insulin; Kidney diseases; Lorazepam; Minerals; Myoclonus; Sympathomimetic agents; Toxicity