What is the dose of Levosalbutamol (albuterol) for hyperkalemia management?

Levosalbutamol (Albuterol) Dosing for Hyperkalemia Management

The recommended dose of levosalbutamol (albuterol) for hyperkalemia management is 5 micrograms/kg administered intravenously over 15 minutes, or 10-20 mg via nebulizer. 1, 2

Intravenous Administration

• IV levosalbutamol at 4-5 micrograms/kg over 15-20 minutes can effectively lower serum potassium by approximately 1.4-1.6 mEq/L 3
• This dosing regimen has been shown to be effective with minimal side effects, even in pediatric patients 1
• The potassium-lowering effect begins within 30 minutes and lasts for at least 2 hours 1

Nebulized Administration

• Nebulized levosalbutamol at doses of 10-20 mg is effective for acute hyperkalemia management 2
• A 10 mg dose can decrease plasma potassium by approximately 0.62 mmol/L, while a 20 mg dose can decrease it by approximately 0.98 mmol/L 2
• When administered as 20 mg nebulized in 4 ml of saline, significant potassium reduction occurs within 40 minutes, with maximal effect at 90 minutes (reduction of 1.12 ± 0.10 mEq/L) 4
• The effect persists for at least 3 hours, with some patients maintaining reduced potassium levels for up to 6 hours 4

Mechanism of Action

• Levosalbutamol works by stimulating beta-2 adrenergic receptors, which activates the sodium-potassium ATPase pump 3
• This causes an intracellular shift of potassium from the extracellular space into skeletal muscle cells 3
• The effect is independent of insulin, aldosterone, or kidney excretion 3

Monitoring and Side Effects

• Monitor heart rate, blood pressure, and respiratory rate during and after administration 4
• Common side effects include:
  • Sinus tachycardia (increased heart rate) 4
  • Fine tremor 4
  • Anxiety 4
  • Modest increase in blood glucose levels 5

Clinical Considerations

• Levosalbutamol is considered a first-line treatment for acute hyperkalemia due to its:
  • Rapid onset of action 4
  • Duration of effect 4
  • Relatively mild side effect profile 4
  • Ability to be repeated if necessary 4
• For patients with severe hyperkalemia (K+ >6.0 mEq/L), consider combining with other treatments such as calcium (for cardiac membrane stabilization), insulin with glucose, or sodium bicarbonate (especially with concurrent metabolic acidosis) 6
• In patients with renal failure, nebulized levosalbutamol at 15 mg over 30 minutes has been shown to decrease serum potassium from 6.5 ± 0.6 mmol/L to 5.6 ± 0.6 mmol/L within 30 minutes, with effects lasting approximately 3 hours 5

Important Caveats

• The potassium-lowering effect is temporary, so definitive treatment to remove excess potassium from the body (such as dialysis, potassium binders, or diuretics in patients with adequate renal function) should be initiated concurrently 6
• Patients with cardiovascular disease and chronic kidney disease are at higher risk of recurrent hyperkalemia and may require more aggressive management 6
• The magnitude of potassium reduction does not necessarily correlate with the initial degree of hyperkalemia 4