[Rapid correction of acute hyperkalemia with nebulized salbutamol]

Fifteen patients on chronic hemodialysis received twenty-two treatments with 20 mg nebulized salbutamol (4 ml of 0.6 g% in 4 ml of saline), to control an episode of acute hyperkalemia, (6.58 +/- 0.14 range: 5.7-7.9 mEq/l) and as a previous step before dialysis. Plasma potassium concentration at 20, 40, 60, 90 and 180 min post-salbutamol, were: 5.85 +/- 0.21, 5.58 +/- 0.21, 5.48 +/- 0.27, 5.46 +/- 0.17 and 5.57 +/- 0.34 mEq/l, respectively. (Fig. 1). The decrease of plasma potassium was significant at 40' and maximal at 90': 1.12 +/- 0.10 mEq/l, and persisted for at least 3 hours (in 3 patients up to 6 hours). No correlation was found between the grade of hyperkalemia and the magnitude of plasma potassium decrease after therapy. The systolic and diastolic blood pressure decreased significantly at 60 and 80 min post-treatment: 134 +/- 6.45 vs 119 +/- 6.79 and 74 +/- 4.12 vs 64.66 +/- 3.88 mmHg (p < 0.02 and p < 0.001). The heart rate and respiratory frequency increased significantly at 60-80 and 20 min respectively (90 +/- 4.45 vs 113 +/- 4.55 beats/min and 19.57 +/- 0.98 vs 23.42 +/- 1.24 resp/min) (p < 0.001) (Table 1). The secondary effects of the administration of the drug, such as sinus tachycardia, fine tremor and anxiety in 6, 4 and 1 patient respectively, were moderate and well tolerated. It is concluded that, due to its technical feasibility, promptness of action, duration of hypokalemic effect, few side effects and repeatability, nebulized salbutamol can be considered a first choice in the treatment of acute hyperkalemia.