Intravenous infusion or nebulization of salbutamol for treatment of hyperkalemia in patients with chronic renal failure.

BACKGROUND: Hyperkalemia is one of the frequent medical emergencies in patients with chronic renal failure (CRF). We studied and compared the efficacy and safety of salbutamol either by intravenous infusion (i.v.) or nebulization (NB) in treating CRF patients with hyperkalemia. METHODS: Thirty-four patients (BUN > 80 mg/dl, serum creatinine > 8.0 mg/dl, and plasma potassium > 5.0 mEq/L) were randomly assigned to receive either i.v. (0.5 mg) or NB (10 mg) treatment of salbutamol. Plasma potassium, sodium, osmolarity, glucose, insulin, PCO2, blood pH, blood pressure and heart rate were monitored. RESULTS: One third of i.v. group and one fourth of NB group of patients were resistant to salbutamol treatment and were excluded from the study. All the baseline data were similar between 2 groups. After treatment, significant decrease in plasma potassium was found in both groups. The maximal reduction of plasma potassium was 0.95 +/- 0.14 mEq/L and occurred 30 minutes after i.v. treatment (n = 12) while it was 0.88 +/- 0.13 mEq/L and occurred 90 minutes after NB treatment (n = 12). During the first ninety minutes after treatments, the decrease of plasma potassium in IV group was faster and greater than in NB group. After that, the hypokalemic effect was more profound in NB group till the end of the study. The hypokalemic effects of both treatments sustained for at least 3 hours. Plasma insulin and glucose increased (p < 0.05) in both groups, whereas blood pH, PCO2, sodium, osmolarity and blood pressure did not change significantly. The reduction of potassium was significantly correlated with the elevation of insulin (i.v.: r = -0.56, p < 0.05; NB: r = -0.54, p < 0.05). Heart rate elevated significantly in both groups; nevertheless, this elevation was less marked in NB group. CONCLUSIONS: Both routes of administration of salbutamol resulted in a prompt and significant decrease of plasma potassium concentrations and both are considered as simple, effective and safe alternatives in treating hyperkalemia in patients with CRF. However, i.v. therapy might be preferred in CRF patients requiring a rapid lowering in plasma potassium; nebulization, on the other hand, should be preferred in CRF patients with coronary artery diseases.