Background: About 65% of poisoning cases are related to children and of these, more than half of the patients are 5-year-old or less. While non-accidental poisoning is rare. We report two cases of intentional salbutamol poisoning in two young siblings presenting separately multiple times over a period of two years with similar presentations of tachycardia, hyperglycemia and hypokalemia. Case Presentation: Two siblings, one 3-year-old boy and the other one, 1 year old girl, presented at emergency department. Both presented with tachycardia and vomiting, while the boy also had hypeglycemia and hypokalemia, and girl also had subjective fever and poor oral intake. Other vital signs, physical examination, HbA1c, genome sequence, and upper gastrointestinal tract examination were all normal. Child protective team was called due to suspension of Salbutamol toxicity and lab work confirmed it. The mother was interviewed who became resentful and refused to undergo any psychological assessment and left the hospital with the children. The mother is suspected of Munchausen syndrome by proxy. Conclusion: Emergency medicine physicians should scrutinize medication side effects and presentation. Active investigation to recognize similar cases of suspected Munchausen Syndrome by proxy in the Saudi community is also warranted. Policymakers should introduce a protocol to deal with victims and affected families.

Keywords: Albuterol, toxicity, poisoning, Munchausen syndrome by proxy, case report.