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.
9 comments:
I started writing a post about this a while ago, and also came to the same conclusion that you did: that ventolin can lower potassium, but doctors don't order a high enough dose to make it worth your time and effort.
Here are some further readings I've found:
low potassium
Here's a couple more related links:
Xoponex just as effective as Albuterol in lowering potassium.
serum potassium
Thanks for the links Rick, I'll check them out.
The docs at my hospital write for the 20mg dose fairly often and it works well. We were concerned about the side effects at first but only people extremely sensitive albuterol show more than a slight elevation of heart rate so that's good. The effects are temporary but it's a nice bandaid while they fix the rest of the metabolic problems that usually go along with it so we've found the tx to be worthwhile.
Thanks for sharing this link, but unfortunately it seems to be offline... Does anybody have a mirror or another source? Please answer to my post if you do!
I would appreciate if a staff member here at respiratorytherapydriven.blogspot.com could post it.
Thanks,
Charlie
I see what your saying about the link only the abstract comes up, somehow I had the full article when I was looking up information on the subject, I'll see if I can find another link.
Good post.
Thanks for that info. Here in Victoria, British Columbia, RT's very seldom give albuterol for hyperkalemia. As other RT's have commented, the requested dose is almost always 2.5 -5.0 mg. Hardly worth the effort.
I found your post because I was looking for the appropriate dose of albuterol to administer for hyperkalemia. In other links, I found the same dosage recommendation. I passed the information to the nurse caring for a patient we have that is experiencing some hyperkalemia in the am. The physcian ordered 2.5mg albuterol. I will pass this information to my counterparts so we can be a more effective team. I also was a combat medic on active duty and then was retrained as an RT in the reserves.
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