From the Guidelines
Salbutamol 10mg nebulization is expected to decrease serum potassium by approximately 0.5 mmol/L, as reported in recent studies 1. The decrease in serum potassium concentration after the use of short-acting β-agonists, such as salbutamol, is typically mild and of uncertain clinical significance.
- The mean decrease in serum potassium concentration is around 0.54 mmol/L in one study and 0.52 mmol/L in another, as noted in the 2023 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1.
- The mechanism involves beta-2 adrenergic stimulation, which activates the sodium-potassium ATPase pump, driving potassium from the extracellular to the intracellular space without changing total body potassium.
- This effect is clinically significant in certain patient populations, such as those with pre-existing hypokalemia, those on potassium-wasting diuretics, or individuals with cardiac conditions, who should be monitored carefully to avoid excessive potassium lowering that can precipitate cardiac arrhythmias.
- The potassium-lowering effect may be more pronounced in patients with underlying lung disease who receive frequent nebulized treatments, highlighting the need for careful monitoring and management in these patients 1.
From the Research
Expected Decrease in Serum Potassium
- The expected decrease in serum potassium after salbutamol 10mg nebulization can be estimated based on the available studies.
- A study published in 1994 2 found that nebulization of salbutamol (10 mg) decreased plasma potassium levels by 0.85 +/- 0.13 mEq/L, with the maximal reduction occurring after 90 minutes.
- Another study published in 1994 3 found that nebulized salbutamol (2.5 mg or 5 mg) decreased plasma potassium concentration by 0.61 mmol/l within 30 minutes of administration.
- A study published in 1996 4 found that nebulized salbutamol (0.15-0.3 mg/kg) decreased serum potassium levels from 3.9 +/- 0.5 mEq/L to 3.7 +/- 0.5 mEq/L, although this study used a lower dose of salbutamol.
Comparison of Administration Routes
- The studies suggest that both intravenous infusion and nebulization of salbutamol are effective in decreasing serum potassium levels 2, 3.
- However, nebulization may be preferred due to its safety profile and lack of major side effects 2, 3.
- The decrease in serum potassium levels may be sustained for at least 3 hours after nebulization 2.
Clinical Implications
- The use of salbutamol for hyperkalemia in children is supported by several studies 5, 6, 4, 3.
- Salbutamol may be a preferred medication for hyperkalemia in children without arrhythmias 6.
- Monitoring of serum potassium concentration may be warranted in patients treated with nebulized salbutamol, especially those on prior oral salbutamol therapy 4.