J Korean Med Sci.  1997 Apr;12(2):111-116. 10.3346/jkms.1997.12.2.111.

Acute therapy for hyperkalemia with the combined regimen of bicarbonate and beta(2)-adrenergic agonist (salbutamol) in chronic renal failure patients

• Kim HJ

• KMID: 1079656
• DOI: http://doi.org/10.3346/jkms.1997.12.2.111

Abstract

This study was aimed to evaluate the efficacy of combination therapy of bicarbonate and salbutamol for hyperkalemia in 9 hemodialysis patients. Simultaneous administration of 8.4% sodium bicarbonate (i.v., 2 mEq/kg) for 1/2 hour and salbutamol (15 mg) in nebulized form for 10 min was compared with treatment modality of either bicarbonate or salbutamol alone. Infusion of sodium bicarbonate induced a significant rise in plasma bicarbonate from 17.3 +/- 3.2 to 22.1 +/- 2.4 mEq/L (p < 0.01), but was ineffective in lowering plasma potassium (-0.13 +/- 0.06 mEq/L). As expected, salbutamol significantly lowered plasma potassium (-0.57 +/0 0.03 mEq/L, p < 0.02 vs. basal value) in all except 2 patients. The combined regimen of bicarbonate and salbutamol to a total 9 patients including 2 patients without hypokalemic effect to salbutamol alone revealed a substantially greater fall in plasma potassium (-0.96 +/- 0.08 mEq/L, p = 0.000 vs. either drug alone) accompanied with significant increase in plasma bicarbonate and blood pH. Treatment with salbutamol or the combined regimen produced slight increases in heart rate but not in blood pressure. It is concluded that the combined regimen of bicarbonate and beta(2)-adrenergic agonist (salbutamol) could be recommended as an efficient alternative for severe hyperkalemia in uremic patients, and is suggested that the enhanced transcellular hypokalemic effects of salbutamol in this combined regimen with bicarbonate would be related to the activation of Na-K pump with acute correction of underlying metabolic acidosis.

MeSH Terms

Adrenergic beta-Agonists/therapeutic use*
Adult
Albuterol/therapeutic use*
Blood Pressure
Drug Therapy, Combination
Female
Heart Rate
Human
Hydrogen-Ion Concentration
Hyperkalemia/physiopathology
Hyperkalemia/drug therapy*
Hyperkalemia/blood
Kidney Failure, Chronic/physiopathology
Kidney Failure, Chronic/drug therapy*
Male
Middle Age
Potassium/blood
Sodium Bicarbonate/therapeutic use*
Sodium Bicarbonate/pharmacokinetics