The dose‐related hyper‐and‐hypokalaemic effects of salbutamol and its arrhythmogenic potential

Abstract

1 The hypokalaemic effect of salbutamol after more than 30 min of administration has been well described. A hyper-and-hypokalaemic effect for adrenaline has been reported, but no such hyperkalaemic effect for salbutamol. 2 The possible hyper-and-hypokalaemic effects of salbutamol with the concomitant potential for pro-arrhythmia were assessed in the baboon (Papio ursinus). 3 Male and femal baboons were anaesthetized with ketamine (15 mg kg-') and maintained with 6% pentobarbitone as spontaneously breathing animals. Six baboons in each group received either 10, 100 or 500 jg kg-' salbutamol i.v. Lead II of the ECG and femoral i.a. blood pressure were recorded continuously for 10 min. Arterial blood samples were collected at 0 min and then after 3 and 10 min of salbutamol administration. 4 All the animals developed sinus tachycardia (above 200 beatsmin-') within 30s of each dose of salbutamol administration and the high heart rate persisted throughout the experiment. All the animals were hyperkalaemic after 3 min and hypokalaemic after O min for each dose of salbutamol. Left ventricular conduction defects were seen in 3 animals during the hyperkalaemic phase. No arrhythmia was seen during the hypokalaemic phase. 5 Salbutamol has a transient hyperkalaemic and a more prolonged hypokalaemic effect in the baboon. The hypokalaemia could not be associated with arrhythmia although conduction defects were associated with the hyperkalaemia. 6 Since salbutamol is used as a bronchodilator in asthmatic patients and to treat acute hyperkalaemia, it is suggested that caution should be exercised when using salbutamol in high doses to treat acute asthma especially during the first few minutes of administration. The finding of hyperkalaemia with salbutamol questions its use in the treatment of hyperkalaemia.

Salbutamol Metered-Dose Inhaler With Spacer for Hyperkalemia

“…The initial rise in serum potassium levels following the administration of salbutamol has not been previously reported in humans. 27 This omission probably is due to blood sampling at a later time, which is a consequence of relatively slow delivery methods. [7][8][9][10][11] Perhaps the initial rise was missed because the earliest sample was drawn after the effect had disappeared.…”

“…Catecholamines have a dual effect: through ␤-receptor stimulation, they may lower serum potassium levels, but through ␣-receptor activation, they may elevate serum potassium levels. 5,[27][28][29][30][31][32] The rapid rise in serum potassium levels is attributed to the release of potassium from the liver. 5,28 -30 The ␣-effect occurs first, but is of short duration and appears more quickly.…”

β-2 Adrenergic Receptor Diplotype Defines a Subset of Salt-Sensitive Hypertension

“…Although this mechanism would not account for the rapid fall in serum potassium often clinically observed with ␤ 2 agonist therapy, it may explain the longer-term changes seen in some experimental models. 60 The sample size of our cohort may limit our statistical power to detect weak associations. For example, although we did not detect an association between genotype and hypertension, per se, our ability to detect such an association may have been limited by the relatively small number of normotensive subjects in our cohort.…”

Salbutamol to facilitate management of acute hyperkalemia in liver transplantation: a case report

“…5,21 Although this response is minor (0.15 mEq l −1 ) 5 or transient (less than 3 min), 5,21 in cases of excessive hyperkalemia, it is prudent to administer calcium salts immediately before initiating nebulized salbutamol.…”