Hypokalaemia Induced by Inhalation of Fenoterol

Haalboom, J. R. E.; Deenstra, M.; Struyvenberg, A

doi:10.1016/s0140-6736(85)92432-8

Cited by 89 publications

(21 citation statements)

References 10 publications

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“…Cardiovascular effects include diastolic hypotension, 83 arrhythmias, and prolonged QTc interval with hypokalemia. 84 Hypokalemia is the result of intracellular potassium shifting from an increased number of sodium-potassium pumps. 85 …”

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confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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“…Long-term use of fenoterol has been shown to lead to worsening asthma and reduced lung function, when compared with terbutaline [9]. The repeated self-administered use of the high dose preparation of fenoterol could result in increased adverse cardiac affects [8], more marked hypokalaemia [10], and a greater delay in seeking medical advice, compared with salbutamol or terbutaline.…”

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confidence: 99%

Prescribed drug therapy and near-fatal asthma attacks

Burgess¹,

Pearce²,

Thiruchelvam³

et al. 1994

Eur Respir J

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P Pr re es sc cr ri ib be ed d d dr ru ug g t th he er ra ap py y a an nd d n ne ea ar r--f fa at ta al l a as st th hm ma a a at tt ta ac ck ks s The relative risk of a near-fatal asthma attack in patients prescribed inhaled fenoterol was 2.00 (95% confidence interval (CI) 1.35-2.97). An increased risk was also observed for oral theophylline (odds ratio (OR) = 1.88; 95% CI 1.26-2.79). For the 65 cases and 104 controls who had a previous admission for asthma in the previous 12 months, information relating to the previous admission was also collected; an increased risk was once again observed for inhaled fenoterol (OR = 2.18; 95% CI 1.10-4.33) and for oral theophylline (OR = 1.18; 95% CI 0.99-3.57). No other asthma drugs showed significantly increased risks. Although the ICU admission cases had generally been prescribed more asthma drugs than the hospital admission controls, and appeared to have more severe asthma, it is possible that the findings reported here are influenced by confounding by severity.We nevertheless estimate that our findings are consistent with the hypothesis that fenoterol increases the risk of near-fatal asthma attacks, and that they complement previous findings on fatal asthma attacks. They also provide some support to previous concerns about the safety of oral theophyllines, although the evidence for this is less consistent.

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“…despite demonstrating a similar fall in serum K+ to that seen in both normal subjects and patients with airflow ob struction 121. 24,25]. Finally we examined potential pre disposing factors for the development of arrhythmias in these subjects but, perhaps surprisingly, we were unable to demonstrate a significant association (or even a trend towards significance) between ventricular ectopic rates or arrhythmias and any of the measured parameters of the severity of airflow obstruction or cardiovascular function.…”

Section: Discussionmentioning

confidence: 78%

“…in a double-blind study of 10 mild asthmatics [24]. Only one study of asthmatics has shown arrhythmias with P-ago nists, therefore, though the increased QTc interval [23, 241 and the hypokalaemia caused by P-agonists [24,25] continue to suggest the potential selling for such arrhyth mias. These are studies of small numbers of mainly young patients with generally stable asthma.…”

Section: Discussionmentioning

confidence: 99%

Effect of High-Dose Salbutamol on Cardiac Rhythm in Severe Chronic Airflow Obstruction: A Controlled Study

Hall

Woodhead²,

Johnston³

1994

Respiration

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Despite concern over possible adverse cardiac effects of high-dose β-agonists there have been no controlled studies of the effects of such a therapy in patients with severe chronic airflow obstruction (CAO). We therefore studied 22 CAO patients (FEV < 1 litre) with continuous ambulatory cardiac monitoring. Patients received either nebulised salbutamol (5 mg) or saline each given 4 times daily for 24 h on 2 consecutive days, single blind, in random order. Supraventricular arrhythmias were common on both saline and salbutamol days (8 vs. 9 patients, p = NS), but none were clinically apparent. There were no episodes of ventricular tachycardia. Ventricular ectopic activity was highly variable but did not significantly differ between the two study days overall or between specific periods after nebulised salbutamol or saline. Serum potassium (mean) fell by 0.23 (SD 0.06) mmol/l in 10 patients after salbutamol. Baseline FEV₁, PaO₂ PCO₂ were not predictive of arrhythmias or ectopic activity. While occasional adverse effects cannot be excluded, we conclude that high-dose salbutamol does not lead to any general increase in ar-rhythmogenic potential in severe CAO.

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Hypokalaemia Induced by Inhalation of Fenoterol

Cited by 89 publications

References 10 publications

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Prescribed drug therapy and near-fatal asthma attacks

Effect of High-Dose Salbutamol on Cardiac Rhythm in Severe Chronic Airflow Obstruction: A Controlled Study

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