Hypokalemic Effects of Intravenous Infusion or Nebulization of Salbutamol in Patients With Chronic Renal Failure: Comparative Study

Liou, Hung-Hsiang; Chiang, Shooh-Shan; Wu, Shih-Chun; Huang, Tung-Po; Campese, Vito M.; Smogorzewski, Miroslaw; Yang, Wu-Chan

doi:10.1016/s0272-6386(12)80983-8

Cited by 50 publications

(36 citation statements)

References 24 publications

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“…The intravenous injection of 0.5 mg albuterol had a faster onset and time to reach nadir. Intravenous injection decreased the serum potassium concentration by approximately 1 mEq/l, but, as expected, tachycardia was more often observed than with the nebulizer route [16]. No β 2 -selective agent is currently approved for intravenous use for the treatment of hyperkalemia in the USA.…”

Section: Short-term Plans For Therapy Of Hyperkalemiamentioning

confidence: 81%

Therapeutic Approach to Hyperkalemia

Kim

Han²

2002

Nephron

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The foremost step in the initial clinical management of hyperkalemia is to decide whether a hyperkalemic patient requires immediate treatment to avoid a life-threatening situation (serum potassium concentration >6.0 mEq/l and EKG changes). When the decision for urgent treatment of hyperkalemia is based on EKG changes, an important caveat for clinicians is that absent or atypical EKG changes do not exclude the necessity for immediate intervention. Once an urgent situation has being handled with intravenous push of a 10% calcium salt, the initiation of short-term measures can be launched by either a single or combined regimen of the three agents that cause a transcellular shift of potassium – insulin with glucose, β₂-agonist (albuterol), and NaHCO₃. As the first choice among these available options, we favor an intravenous bolus of 10 units of insulin with 50 ml of 50% glucose alone or in combination with 10–20 mg of albuterol by nebulizer. These can be repeated as required until the institution of hemodialysis. The combination of insulin with glucose and NaHCO₃ as an another option needs further clarification for its additive effects. However, NaHCO₃ has lost its favor because of its poor efficacy as a potassium-lowering agent when used alone. The next step is to remove potassium from the body – diuretics (furosemide), cation exchange resin (kayexelate) with sorbitol, and dialysis (preferably hemodialysis). The final important step for the managements of hyperkalemia is a long-term plan to prevent its recurrence or worsening. In addition to every effort to elucidate underlying causes and pathophysiologic mechanisms for hyperkalemia, an extensive search must be made to uncover overt or sometimes covert medications that may have led to the development of hyperkalemia. Furthermore, one must obtain detailed dietary and medical history of hyperkalemic patients.

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Section: Short-term Plans For Therapy Of Hyperkalemiamentioning

confidence: 81%

Therapeutic Approach to Hyperkalemia

Kim

Han²

2002

Nephron

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“…This shift can be achieved by intravenous insulin (10 units regular insulin + 50 ml of 50% dextrose to prevent hypoglycemia) (3,4) and the beta-2 adrenergic agonist albuterol (0.5 mg IV bolus or 10-20 mg nebulized over 10 minutes) (3)(4)(5)(6). Nebulized albuterol is as effective as intravenous albuterol in lowering plasma potassium acutely but is better tolerated (7). The potassium lowering effects of insulin and abuterol are additive (3,4).…”

mentioning

confidence: 99%

Medical and dialytic management of hyperkalemia in hemodialysis patients

Allon

1996

Int J Artif Organs

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“…Although this phenomenon could be expected it has so far not been reported in children with hyperkalaemia treated with salbutamol [9,10]. Only Liou et al [8] reported a significant increase in heart rate at 10, 20 and 30 min in adults after salbutamol infusion but not after inhalation, while others found no significant influence on myocardial perfusion, blood pressure or heart rate [2,3,7].…”

Section: Discussionmentioning

confidence: 99%