Intravenous versus Nebulized Salbutamol in Acute Treatment of Hyperkalemia
Date First Published:
January 29, 2016
Last Updated:
January 29, 2016
Report by:
Brendan Parker, Student (University of Toledo College of Medicine)
Three-Part Question:
In [patients with hyperkalemia] is [IV Salbutamol more beneficial than nebulized Salbutamol] in [reducing potassium blood levels]?
Clinical Scenario:
67yo female with past a medical history of chronic kidney failure presents with chest pain and fatigue. EKG shows wide QRS complex and peaked T waves. iStat shows potassium of 8.3mEq/L. While starting hyperkalemia treatment with Calcium Gluconate, Insulin + Dextrose, nebulized Salbutamol, and Kayexalate, you question whether nebulization or intravenous administration of Salbutamol is more effective in decreasing plasma potassium levels.
Search Strategy:
PubMed Search (Nov 2015)
Search Details:
"albuterol"[MeSH Terms] AND "hyperkalemia"[MeSH Terms] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND intravenous[All Fields]
Outcome:
25 papers were found of which four were helpful, which are listed in Table 1 below.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Intravenous infusion or nebulization of salbutamol for treatment of hyperkalemia in patients with chronic renal failure Liou HH, Chiang SS, Wu SC, et al May-94 China | 34 patients. 12 received IV and 12 received nebulization Salbutamol | Randomized Controlled Trial | IV reduced by 0.95mEq +/- 0.14 mEq/L after 30min | First 90 minutes, the decrease of potassium in IV group was faster and greater than in nebulizer group | Small sample size, only patients with chronic renal failure |
| Nebulizer reduced 0.88 +/- 0.13 mEq/L after 90min | Effects of both treatments sustained for at least 3 hours | ||||
| Heart rate elevated in both groups, less in nebulizer group | |||||
| Treatment of hyperkalaemia using intravenous and nebulized salbutamol McClure R, Prasad V, Brocklebank J Apr-91 USA | 11 children received IV and nebulized Salbutamol on separate dates | Randomized Controlled Trial | Serum potassium at 30min | IV reduced 0.87 mmol/L & Nebulized reduced 0.61 mmol/L | Small sample size, only children with end stage chronic renal failure |
| Serum potassium at 120min before 2nd dose | IV reduced 0.43 mmol/L & Nebulized reduced 0.67 mmol/L | ||||
| Serum potassium 30min after 2nd dose (150min) | IV reduced 1.16 mmol/L & Nebulized reduced 1.14 mmol/L | ||||
| Serum potassium 120min after 2nd dose (240min) | IV reduced 0.81 mmol/L & Nebulized reduced 1.14 mmol/L | ||||
| Serum potassium 300min after initial dose | IV reduced 0.70 mmol/L & Nebulized reduced 1.19 mmol/L | ||||
| Hypokalemic effects of intravenous infusion or nebulization of salbutamol in patients with chronic renal failure: comparative study Liou HH, Chiang SS, Wu SC, et al. Feb-94 USA | 10 patients | Comparative Study | IV reduced 0.92 +/- 0.10 mEq/L after 30 minutes | Both treatments significantly decreased plasma potassium in 10 patients and the decrease was sustained for at least 3 hours | Small sample size, only patients with chronic renal failure |
| Nebulizer reduced 0.85 +/- 0.13 mEq/L after 90 minutes | |||||
| Efecto del salbutamol intravenoso vs salbutamol en micronebulizador en la hipercaliemia por insuficiencia renal cronica Balanzario J, Lozano Nuevo JJ, Hernandez Gaeta D, et al Aug-03 Mexico | 68 patients. 34 received IV and 34 received nebulization Salbutamol | Randomized Controlled Trial | Serum potassium at 60min | -IV reduced 0.76 mEq/L & Nebulized reduced 0.69 mEq/L | Only patients with chronic renal failure |
| Serum potassium at 120min | -IV reduced 0.70 mEq/L & Nebulized reduced 0.71 mEq/L |
Author Commentary:
Administration of Salbutamol intravenously or through nebulization resulted in a significant decrease of plasma potassium concentration. Both routes are considered simple, effective and safe ways of treating hyperkalemia. IV administration was reported as quicker action but produced bigger side effects. Multiple papers recommended IV therapy for patients requiring rapid lowering of plasma potassium levels while patients with coronary artery disease should be treated with nebulization.
Bottom Line:
Administration of Salbutamol via intravenous or nebulization is equally effective in the treatment in patients with hyperkalemia.
References:
- Liou HH, Chiang SS, Wu SC, et al. Intravenous infusion or nebulization of salbutamol for treatment of hyperkalemia in patients with chronic renal failure
- McClure R, Prasad V, Brocklebank J. Treatment of hyperkalaemia using intravenous and nebulized salbutamol
- Liou HH, Chiang SS, Wu SC, et al. . Hypokalemic effects of intravenous infusion or nebulization of salbutamol in patients with chronic renal failure: comparative study
- Balanzario J, Lozano Nuevo JJ, Hernandez Gaeta D, et al. Efecto del salbutamol intravenoso vs salbutamol en micronebulizador en la hipercaliemia por insuficiencia renal cronica