Hyperkalaemia: nebulized albuterol lowered potassium dialysis patients

Clinical bottom line (level 4)

  1. Nebulized albuterol over 10 minutes lowered potassium in most haemodialysis patients with hyperkalaemia.
  2. The decrease occurred within 30 minutes and lasted at least 2 hours.
  3. The maximal decrease varied from 1.0 to 1.3 mmol/L, with a greater response using a higher dose of 20 mg.
Allon et al: Annals of Internal Medicine 1989; 110: 426-429
Expires October 2003

The study

Case-control study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.
Setting: university hospital, USA

10 patients (aged ?, ?% male) on a stable regimen of haemodialysis (3-4 hour sessions, thrice weekly), with pre-dialysis plasma potassium concentrations consistently > 5 mmol/L over 4 weeks

Excluded if
  • on beta-blockers


    • Note:
  • Mean baseline potassium levels at the beginning of each set of experiments were similar (5.93 +/- 0.27 for the 10 mg albuterol group, 5.81 +/- 0.41 for the 20 mg albuterol group, and 5.74 +/- 0.24 for the placebo group).


    • Control Group: (n = 9, 9 analysed): Normal saline alone, nebulized over 10 minutes
    Experimental Group: (n = 10, 10 analysed): albuterol (10 mg) nebulized over 10 minutes
    Experimental Group: (n = 8, 8 analysed): albuterol (20 mg) nebulized over 10 minutes

    100% followed for 120 minutes

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    fall in serum potassium: placebo v. 10 mg albuterol -0.36
    (0.05)     		0.62
    (0.09)     		0.98
    (0.91 to 1.1)
    fall in serum potassium: placebo v. 20 mg albuterol -0.36
    (0.05)     		0.98
    (0.14)     		1.3
    (1.2 to 1.4)
    fall in serum potassium: 10 mg albuterol v. 20 mg albuterol 0.62
    (0.09)     		0.98
    (0.14)     		0.36
    (0.25 to 0.48)

    Comments

    1. Small, non-randomized study. Most importantly, 2 out of 8 patients given 20 mg of albuterol had only marginal decreases in potassium; the reason for the "resistance" is unclear, although the 2 patients were the oldest.
    2. pH of patients not sampled, so it is unclear if results are influenced by acidaemia.
    3. Significant falls in potassium levels noted after 30 minutes.
    4. No significant difference in changes in blood pressure or heart rate between 2 groups.

    Citation

    1. Allon M, Dunlay R, Copkney C, et al: Nebulized albuterol for Acute Hyperkalemia in Patients on Hemodialysis. Annals of Internal Medicine 1989; 110: 426-429
    Search Terms: Cochane Library; MesH terms: hyperkalemia
    Contributor: Warren Lee and Chris Ball, October 1999
    Reviewer: .

    Clinical Question.
    Patient chronic renal failure on haemodialysis
    Intervention or Exposure albuterol, salbutamol
    Outcome fall in potassium