Mandelberg A, Krupnik Z, Houri S, Smetana S, Gilad E, Matas Z, Priel I E
Department of Pulmonary Medicine, The Edith Wolfson Medical Center, Hulon, Israel.
Chest. 1999 Mar;115(3):617-22. doi: 10.1378/chest.115.3.617.
To determine the efficacy of inhaled salbutamol (rapidly delivered, using a metered-dose inhaler with a spacer device [MDI-S]) in lowering the serum potassium levels in patients with hyperkalemia.
A randomized, double-blind, placebo-controlled trial.
Seventeen chronic renal failure patients referred to the Nephrology Unit between October 1, 1997 and March 31, 1998 for hemodialysis were randomized.
Group 1 received salbutamol followed by a placebo. Group 2 received a placebo followed by salbutamol. Each patient inhaled 1,200 microg salbutamol or a placebo through an MDI-S within 2 min. Blood samples were obtained repeatedly before inhalation and after 1, 3, 5, 10, and 60 min. The pulse rate and blood pressure were repeatedly measured. Insulin levels were examined in a subset of patients (n = 10) before, and 1 and 5 min following inhalation. Salbutamol's known side effects, palpitation, tachycardia tremor, and headache, were recorded. Potassium levels rose after 1 min following the completion of treatment and then decreased steadily thereafter. A rise of > or = 0.1 mEq/L was seen in 10 of 17 patients (59%) during the treatment period and there was no change (0%) seen during the placebo period (p < 0.0001). Within 3 min after inhalation of salbutamol, potassium levels declined as a function of time. Potassium levels in those patients taking the placebo did not change as a function of time (p < 0.001). The difference between the placebo and the salbutamol-treated periods reached significance after 5 min (p < 0.05). The serum glucose levels rose following inhalation of salbutamol, with a significant rise after 3 min. The heart rate rose significantly within the first 5 min following inhalation. Serum insulin levels remained unchanged 1 min after inhalation; however, after 5 min, a significant elevation was detected.
Salbutamol inhalation of 1,200 microg, using an MDI-S, has a relatively rapid onset of action that induces a consistent reduction in serum potassium levels, starting 3 to 5 min following delivery. Unexpectedly, a paradoxical elevation was detected in serum potassium levels in the first minutes following inhalation. This effect, although minor (0.15 mEq/L above baseline), may cast some doubt on the role of salbutamol inhalation as the first treatment for excessive hyperkalemia.
确定吸入沙丁胺醇（使用带储雾罐的定量吸入器[MDI-S]快速给药）降低高钾血症患者血清钾水平的疗效。
一项随机、双盲、安慰剂对照试验。
1997年10月1日至1998年3月31日期间转诊至肾脏病科进行血液透析的17例慢性肾衰竭患者被随机分组。
第1组先吸入沙丁胺醇，后吸入安慰剂。第2组先吸入安慰剂，后吸入沙丁胺醇。每位患者通过MDI-S在2分钟内吸入1200微克沙丁胺醇或安慰剂。在吸入前以及吸入后1、3、5、10和60分钟重复采集血样。重复测量脉搏率和血压。在一部分患者（n = 10）中，于吸入前以及吸入后1和5分钟检测胰岛素水平。记录沙丁胺醇已知的副作用，如心悸、心动过速、震颤和头痛。治疗结束后1分钟血钾水平升高，此后逐渐下降。17例患者中有10例（59%）在治疗期间血钾水平升高≥0.1 mEq/L，而在安慰剂期间无变化（0%）（p < 0.0001）。吸入沙丁胺醇后3分钟内，血钾水平随时间下降。服用安慰剂的患者血钾水平未随时间变化（p < 0.001）。安慰剂组和沙丁胺醇治疗组之间的差异在5分钟后达到显著水平（p < 0.05）。吸入沙丁胺醇后血清葡萄糖水平升高，3分钟后显著升高。吸入后前5分钟内心率显著升高。吸入后1分钟血清胰岛素水平保持不变；然而，5分钟后检测到显著升高。
使用MDI-S吸入1200微克沙丁胺醇起效相对较快，给药后3至5分钟开始可使血清钾水平持续降低。出乎意料的是，吸入后最初几分钟血清钾水平出现反常升高。这种效应虽然较小（比基线高0.15 mEq/L），但可能会使人对吸入沙丁胺醇作为重度高钾血症的首选治疗方法的作用产生一些怀疑。
