how useful is Albuterol in hyperkalemia?

6 Jan

Nice recent review from Dr. Smith’s ECG Blog:

HOW MUCH DOES ALBUTEROL CHANGE THE POTASSIUM?

  • 10 mg neb (e.g 4x 2.5mg nebs over 10 min) lowers it by about 0.6 mEq/L.
  • 20 mg neb (most are 2.5 mg) lowers it by about 1.0 mEq/L.  
  • 0.5 mg of IV albuterol reduces K by about 1.2 mEq/L. 

 

WHEN DOES IT WORK?

one study – IV albuterol – maximal reduced serum K+ at 30-60 min

another study – 10mg albuterol neb maximal decrease at ~90 min

 

TIMETABLES FOR COMPARISON:

  • insulin + glucose: effect begins in 10-20 minutes, peaks at 30-60 minutes, and lasts 4-6 hours
  • sodium bicarbonate: in one series, little effect at 1-2 hours but lowered K+ from 6 meq/L at to 5.4 at 4-6 hours

 

BOTTOM LINE:

albuterol helps temporarily shift the K+ in a hyperkalemia patient, but going to need a handful of nebs at a time

add it to the mix, but make sure to use it with other methods in a high K+ patient

 

References: Dr. Smith’s ECG Blog; uptodate.com: Treatment and prevention of hyperkalemia in adults; picture

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