What is the recommended dose of Asthalin (salbutamol) for nebulisation in a patient with hyperkalemia?

Salbutamol (Asthalin) Nebulization for Hyperkalemia

Recommended Dose

For acute hyperkalemia management in adults, administer salbutamol 10-20 mg via nebulization over 15 minutes. 1

Dosing Details and Administration

• Standard adult dose: 10-20 mg nebulized over 15 minutes provides effective potassium lowering 1
• Alternative dosing: 10 mg nebulized salbutamol produces maximal potassium reduction of approximately 0.88 mEq/L at 90 minutes 2
• Higher dose option: 15 mg nebulized over 30 minutes has been shown effective in renal failure patients, reducing serum potassium from 6.5 mmol/L to 5.6 mmol/L within 30 minutes 3
• The 20 mg dose produces peak effect at 90 minutes with a mean reduction of 1.18 mmol/L 4
• The 10 mg dose achieves peak effect at 120 minutes with a mean reduction of 1.29 mmol/L 4

Onset and Duration of Action

• Onset: Potassium lowering begins within 30 minutes of nebulization 3, 2
• Peak effect: Occurs at 90-120 minutes depending on dose 4, 2
• Duration: The hypokalemic effect persists for at least 3 hours, with some effect lasting up to 6 hours 3, 2
• Important caveat: This is a temporizing measure only—the effect is transient and does not remove potassium from the body 1

Clinical Efficacy

• Nebulized salbutamol is as effective as intravenous salbutamol for hyperkalemia treatment 4, 2
• Comparable efficacy to insulin-dextrose therapy 4
• More effective than sodium bicarbonate at 60 minutes (mean difference -0.46 mmol/L) 4
• Approximately 25-33% of patients may be resistant to salbutamol treatment 2

Safety Profile and Monitoring

• Common side effects: Modest increase in heart rate (less pronounced with nebulized versus IV route), mild elevation in blood glucose 3, 2
• Serious adverse events: Rare with nebulized route; well-tolerated even in patients with coronary artery disease 2
• Cardiac monitoring: Required for severe, life-threatening hyperkalemia with ECG changes 1
• Nebulized route is preferred over IV in patients with coronary artery disease due to less marked heart rate elevation 2

Critical Management Considerations

• Simultaneous treatments: For severe hyperkalemia with ECG changes, consider multiple simultaneous interventions including calcium administration 1
• Definitive therapy required: Salbutamol only shifts potassium intracellularly; definitive removal via diuretics, potassium binders, or dialysis remains necessary 1
• Mechanism: Works via beta-2 receptor stimulation, increasing Na-K-ATPase activity to drive potassium into skeletal muscle cells 5
• The potassium-lowering effect is mediated independently of insulin, aldosterone, or renal excretion 5

Pediatric Dosing

• IV route in children: 4-5 mcg/kg over 15-20 minutes produces mean potassium reduction of 1.4-1.6 mEq/L without significant side effects 5, 6
• Single IV infusion of 5 mcg/kg is highly effective with minimal side effects in children aged 0.1-14 years 6
• Effect lasts at least 120 minutes and may reverse hyperkalemia without further intervention in some pediatric patients 6