Treatment of hyperkalaemia in renal failure with salbutamol inhalation

Abstract

The aim of this study was to investigate whether beta-2-adrenergic stimulation with inhaled salbutamol is therapeutically useful in hyperkalaemia. Ten patients with renal failure and hyperkalaemia (serum potassium concentration greater than 6 mmol l-1) were given 15 mg salbutamol via a nebulizer over a 30-min period. Serum potassium was measured 30, 60, 180 and 360 min thereafter. All patients had end-stage renal failure on chronic hospital haemodialysis. Serum potassium levels decreased significantly from a pretreatment value of 6.5 +/- 0.6 mmol l-1 to 5.6 +/- 0.6 mmol-1 after 30 min, and this level was maintained for 3 h. Six hours after treatment, the serum potassium concentration was 6 +/- 0.7 mmol l-1. There was a modest increase in heart rate and blood glucose level, but otherwise salbutamol was well tolerated and no serious side-effects occurred. It is concluded that the administration of salbutamol by inhalation is a simple, safe and reasonably effective method for treatment of hyperkalaemia in renal failure.

Effect of inhaled albuterol on whole blood potassium concentrations in dogs

“…These results are similar to findings in humans after inhaled or nebulized albuterol in which the mean maximum decrease in serum potassium ranges from 0.3 to 0.9 mmol/L. 18,24,[32][33][34][35][36][37] The potassium lowering effects of inhaled albuterol in normokalemic dogs reported in the current study might underestimate the expected magnitude of reduction in dogs with hyperkalemia. There have been no studies comparing the potassium lowering effects of albuterol in normokalemic and hyperkalemic human patients.…”

“…Human literature has found interindividual variation, with some patients appearing relatively resistant to the potassium lowering effect of albuterol. 20,24,34 The cause for this lack of expected potassium lowering effect of albuterol in a subset of patients is unknown although 1 theory suggests it could be related to elevated circulating concentrations of endogenous catecholamines. 21 One potential explanation for the variability in our study could be related to the reluctance of some dogs to breathe normally with the silicone facemask placed onto their muzzle.…”

“…Albuterol is commonly used alone or with regular insulin and dextrose to treat moderate‐to‐severe hyperkalemia in humans and can be administered via inhalation or as an IV infusion 20‐22 . In humans, albuterol IH decreases serum potassium concentrations within 15 to 30 minutes of administration, with duration of effect lasting up to 180 minutes, making it an ideal intervention 18‐24 . Tachycardia and hyperglycemia are reported potential adverse effects to albuterol administration in humans 25‐27 .…”

Prise en charge de l’hyperkaliémie aux urgences

“…L'efficacité maximale du salbutamol sur la diminution du potassium est observée entre 30 et 60 min et dure environ deux heures. Les résultats des différentes études sont présentés dans l'Annexe A [24][25][26][27][28][29]. En résumé, avec l'utilisation des β2 mimétiques, la diminution de la kaliémie est d'environ 1 mmol/l en 60 min, avec une efficacité similaire entre une utilisation intraveineuse (à la dose de 0,5 mg sur 15 min) ou en nébulisation (meilleure efficacité à une dose de 20 mg qu'à 10 mg) [20].…”

Formulation, Stability and Bioequivalency Study of Prepared Salbutamol Sulphate Nebules.

“…Inhalation of salbutamol sulphate via a nebulizer is an integral component of modern treatment of airway diseases, particularly for patients unable to use metered dose inhalers (3,4) . Also it is effective in treatment of hyperkalemia in patients with chronic renal failure (5,6) . The usual dose of salbutamol nebules is 2.5-5mg in 2.5ml which can be diluted with sodium chloride 0.9% and given as single dose and can be repeated up to 12 times per day in hospital with monitoring (7) .…”