Salbutamol infusion to treat neonatal hyperkalaemia

Abstract

Salbutamol infusion, 4 micrograms/kg in 5 ml of water infused for 20 minutes, was given to treat hyperkalaemia (potassium level > 6.0 mmol/l) in 10 critically ill preterm infants (median gestational age 26 weeks). Seven infants had acute renal failure, two had persistent metabolic acidosis without renal failure and the remaining infant had a combination of acute renal failure and persistent metabolic acidosis. No infant developed a tachycardia or became hyperglycaemic in response to the infusion. Seven of the 10 infants ultimately died but this was at a mean of 9 days following the infusion and as a consequence of complications due to their extreme prematurity or major congenital abnormality. In response to the infusion the potassium level fell in 7 infants with acute renal failure by a median of 1.1 mmol/l (range 0.7-1.8) at one hour but in the three infants with a persistent metabolic acidosis, the potassium level continued to rise. We conclude that salbutamol infusion achieves, without side-effects, at least a temporary reduction in hyperkalaemia in preterm infants with renal failure, but not metabolic acidosis. Its effect is of sufficient duration to allow ample time for definitive therapy to be instituted and thus may be a useful alternative for infants in whom the possible hypoglycaemic side-effects of glucose and insulin should be avoided.

In vitro Analysis of the Na⁺-K⁺ ATPase Activity in Neonatal and Adult Red Blood Cells

“…This drug has been found effective when ad ministered via either the respiratory or the intravenous route, and is believed to reduce the serum potassium levels by increasing the rate of flux of the cytoplasmic-membraneassociated Na+-K+ ATPase. There are two reports in the literature describing the use of albuterol to treat hyperkalemia in preterm neonates [16,17], Both reports concluded that albuterol was effective in acutely lower ing the serum potassium levels of these neo nates.…”

Preeclampsia and Na,K-ATPase Activity of Red Blood Cell Ghosts from Neonatal and Maternal Blood

“…In this regard, Whaun and Oski [24] have proposed that the shortened survival of the erythrocytes of the neonate might be a consequence of a low Na,KATPase activity of their membranes. Besides, it has been demonstrated [25] that preterm newborns are able to tolerate very high serum potassium concentrations without lethal arrhythmias. A low activity of the Na,KATPase could explain this finding.…”

Hyperkalemia in very low birthweight infants: incidence and associated factors

“…O valor de KP igual ou superior a 6 mEq/l foi escolhido como elevado no presente estudo por ser o nível aceito como anormal para RNPs segundo diversos autores [11][12][13][14][15] que avaliaram populações de RNPs com idade gestacional similar.…”

“…Tomando-se níveis acima de 6,7 mEq/l como alterados, a incidência de hipercalemia nos RNPs foi de 15 Os dados encontrados na presente pesquisa mostram uma incidência mais baixa de hipercalemia,tomando-se como referência níveis de KP superiores a 6,7 mEq/l. O fato de a incidência de hipercalemia ser menor que as relatadas por Gruskay e colaboradores 1 e por Shaffer e colaboradores 5 se deve provavelmente a uma idade gestacional maior na população estudada, 29 semanas, contra 25 semanas na amostra de outros autores.…”

“…Grupo com potássio normal (KN), com valores de KP inferior a 6 mEq/L, e grupo com potássio elevado (KE), com valores iguais ou superiores a 6 mEq/L. Os valores usados como normais estão baseados em dados da literatura 13,14,15 .…”