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Nebulized salbutamol with or without glucose and insulin to treat hyperkalemia: a randomized controlled trial

Supervía A, Clemente C, Aranda MD, López Casanova MJ, Pallàs O, Iglesias ML

Servicio de Urgencias, Hospital Universitario del Mar, Barcelona, Spain. Servicio de Urgencias, Consorci Sanitari Parc Tauli, Sabadell, Barcelona, Spain.

Background and objective: Hyperkalemia is a life-threatening condition that is detected
fairly often in the hospital emergency department. Treating hyperkalemia with β2-
adrenergic drugs in association with other agents has been recommended. This study
aimed to compare the efficacy of nebulized salbutamol alone or in combination with
insulin and glucose to treat hyperkalemia.
Patients, material and methods: Prospective randomized controlled trial enrolling
patients with hyperkalemia (potassium level >5.5 mEq/L). Patients were assigned to a
monotherapy group (nebulized salbutamol alone) or a combined therapy group
(salbutamol plus insulin and glucose). If acid-base imbalance was detected, sodium
bicarbonate was also administered. We recorded patient characteristics, medical history,
current medication that might cause high potassium concentrations, plasma potassium
concentration, and discharge diagnosis. Variables were compared between groups.
Results: Eighty-one patients (40 in the monotherapy group) were enrolled. The mean
(SD) potassium concentration at baseline was lower in the monotherapy group (6.35
[0.04] mEq/L) than in the combined-therapy group (6.88 [0.7] mEq/L) (P<.001). Mean
potassium levels were significantly lower in both groups 3 hours after treatment, falling
to 0.4 (0.7) and 0.59 (0.6) mEq/L, respectively (P<.001 in both comparisons). The
posttreatment and initial potassium concentrations were unrelated. No between-group
treatment effect on the reduction of plasma potassium concentration was found.
Potassium reduction was uninfluenced by the patient's medical history, including the use
of medications that potentially lead to hyperkalemia.
Conclusion: The effect of nebulized salbutamol alone on hyperkalemia is similar to the
effect of combining salbutamol with insulin and glucose.

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