Salbutamol metered-dose inhaler with spacer for hyperkalemia: How fast? How safe?

Avigdor Mandelberg*, Zipora Krupnik, Sion Houri, Shmuel Smetana, Ely Gilad, Zipora Matas, Israel E. Priel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine the efficacy of inhaled salbutamol (rapidly delivered, using a metered-dose inhaler with a spacer device [MDI-S]) in lowering the serum potassium levels in patients with hyperkalemia. Design: A randomized, double-blind, placebo-controlled trial. Patients: Seventeen chronic renal failure patients referred to the Nephrology Unit between October 1, 1997 and March 31, 1998 for hemodialysis were randomized. Intervention and results: Group 1 received salbutamol followed by a placebo. Group 2 received a placebo followed by salbutamol. Each patient inhaled 1,200 μg salbutamol or a placebo through an MDI-S within 2 min. Blood samples were obtained repeatedly before inhalation and after 1, 3, 5, 10, and 60 min. The pulse rate and blood pressure were repeatedly measured. Insulin levels were examined in a subset of patients (n = 10) before, and 1 and 5 min following inhalation. Salbutamol's known side effects, palpitation, tachycardia tremor, and headache, were recorded. Potassium levels rose after 1 min following the completion of treatment and then decreased steadily thereafter. A rise of ≥ 0.1 mEq/L was seen in 10 of 17 patients (59%) during the treatment period and there was no change (0%) seen during the placebo period (p < 0.0001). Within 3 min after inhalation of salbutamol, potassium levels declined as a function of time. Potassium levels in those patients taking the placebo did not change as a function of time (p < 0.001). The difference between the placebo and the salbutamol-treated periods reached significance after 5 min (p < 0.05). The serum glucose levels rose following inhalation of salbutamol, with a significant rise after 3 min. The heart rate rose significantly within the first 5 min following inhalation. Serum insulin levels remained unchanged 1 min after inhalation; however, after 5 min, a significant elevation was detected. Conclusion: Salbutamol inhalation of 1,200 μg, using an MDI-S, has a relatively rapid onset of action that induces a consistent reduction in serum potassium levels, starting 3 to 5 min following delivery. Unexpectedly, a paradoxical elevation was detected in serum potassium levels in the first minutes following inhalation. This effect, although minor (0.15 mEq/L above baseline), may east some doubt on the role of salbutamol inhalation as the first treatment for excessive hyperkalemia.

Original languageEnglish
Pages (from-to)617-622
Number of pages6
JournalChest
Volume115
Issue number3
DOIs
StatePublished - 1999
Externally publishedYes

Keywords

  • Chronic renal failure
  • Hyperkalemia
  • Hypokalemia
  • MDI
  • Potassium
  • Salbutamol
  • Spacer device
  • β-agonist

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