Tuesday, August 31, 2010

Giving Albuterol to decrease potassium.

Lately we at my humble hospital have been getting more and more orders for albuterol nebulizer treatments to decrease a elevated potassium level in a patient. This has made me curious as to why this works and if it really is a viable reason to give albuterol and a elevated potassium situation so I did some digging and here are some facts I found:

- Potassium is both an electrolyt and a mineral. It helps keep the water and electrolyte balance of the body. Potassium is also important in how nerves and muscles work.
- The normal level of potassium is 3.5-5.0 mEq/L
- Albuterol works to create smooth muscle relaxation through the beta-2 receptor site but one of it's other effects, is to reduce extracellular potassium concentrations by pushing the potassium into the cells. This action is quite handy, in a pinch, but do not rely on it because the action is too slow in it's onset to be of emergent help.
- Doses of 15 mg albuterol via nebulizer, hyperkalemic patients on hemodialysis experienced a 0.9 mEq/L decrease in plasma potassium which was sustained for 6 hours. Albuterol may stimulate sodium-potassium ATPase, resulting in an intracellular shift of potassium.
- Albuterol works to lower potassium concentrations by stimulating the release of insulin. This release of insulin shifts the potassium into the cells thus lowering the potassium level.
- Albuterol also stimulates the Na/k+ pump causing potassium to be shifted into the cells.
- A study compared the efficacy of 1) insulin + glucose. 2) albuterol and 3) both regimens combined when used to lower potassium concentrations. The study found that albuterol was just as effective and quick at lowering potassium concentration as insulin + glucose. The study also found that the two treatments administered together worked even better in reducing potassium level. Albuterol reduced the potassium level by up to almost 1mEq (0.62 - 0.98mEq).
- Using a large amount of albuterol in a patent not in hyperkalemia may cause the patient to become hypokalemic.
- The dose for albuterol when administered in hyperkalemia is 10-20mg.
- It is mentioned in ACLS for Experienced Providers (2003) p.162.
  • For moderate elevation of potassium (6 to 7 mEq/L):
  • Initiate a temporary intracellular shift of potassium using the following agents:
  • * Sodium bicarbonate: 50 mEq IV or up to 1 mEq/kg over 5 minutes
  • * Glucose/insulin: Mix 10 U regular insulin and 25 g (50 mL of D50) glucose, and give IV over 10 to 15 minutes
  • * Nebulized Albuterol: 5 to 20 mg over 15 min.

Well after doing some research on the subject to me it does look like a viable treatment to assist in the treatment of Hyperkalemia in patients, but from what I have been noticing is that the Doctors are not ordering this properly to even make a dent. We here at my hospital get orders for just a regular nebulized albuterol treatment of 2.5mg which is nowhere near the recommended 10-20mg to even cause a dent in the potassium levels.

To be curious about why your doing something is a good thing and the internet is a plethera of information to be found in our profession. If you have questions, research it.

Keep driving on RT's.