Key result
Adding salbutamol to glucose and insulin yields a ~50% greater potassium reduction at 60 minutes.
Why the study?
Does intravenous salbutamol alone or in combination with insulin and glucose improve serum potassium reduction compared to insulin and glucose alone in patients with renal failure and hyperkalaemia?
Does intravenous salbutamol alone or in combination with insulin and glucose improve serum potassium reduction compared to insulin and glucose alone in patients with renal failure and hyperkalaemia?
Absolute Event Rate: -1.5% vs -1%
p-value: p=<0.01
Intravenous salbutamol, either alone or combined with insulin and glucose, provides a greater reduction in serum potassium than insulin and glucose alone in patients with severe renal failure and hyperkalaemia.
May enhance potassium reduction when added to insulin-glucose in renal hyperkalemia; leaves open confirmation in randomized trials.
Three groups of patients with acute or chronic renal failure (GFR less than 5 ml/min) and hyperkalaemia (K+ greater than or equal to 6 mEq/l), similar in age, serum creatinine and pretreatment K+. Group A (n = 24) received salbutamol 0.5 mg i.v. in 15 min, group B (n = 10) received glucose 40 g i.v. plus 10 units insulin i.v. in 15 min, and group C (n = 10) received salbutamol 0.5 mg i.v., glucose 40 g i.v. and insulin 10 units i.v. over a 15-min period. Serum potassium was measured at 30, 60, 180 and 360 min after administration of treatment. All treatments reduced serum potassium, maximal at 30 or 60 min, and ranging from -0.5 +/- 0.1 to -1.5 +/- 0.2 mEq/l; patients in group C exhibited a significantly greater decrement in serum potassium, when compared to group B at 60 (-1.5 +/- 0.2 vs -1 +/- 0.1 mEq/l, respectively; P less than 0.01) and 180 min (-1.2 +/- 0.2 vs -0.7 +/- 0.1 mEq/l, respectively; P less than 0.05). There were no significant differences between groups A and C. Patients from group C had moderate tachycardia and more prolonged hyperglycaemia than those from group B, but all treatments were well tolerated.
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Lane et al. (1989) studied Acute or chronic renal failure and hyperkalaemia (n=44). Salbutamol, glucose, and insulin vs. Glucose 40 g i.v. plus 10 units insulin i.v. in 15 min was evaluated on Decrement in serum potassium at 60 min (p=<0.01). Salbutamol combined with glucose and insulin produced a significantly greater reduction in serum potassium at 60 minutes compared to glucose and insulin alone (-1.5 vs -1.0 mEq/l; P<0.01).
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