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Salbutamol Mechanism Hyperkalaemia — ESENeph MCQ

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EasyElectrolyte DisordersSalbutamol Mechanism HyperkalaemiaESENeph

A 42-year-old man presents with serum potassium 7.0 mmol/L. ECG shows tall peaked T waves but normal QRS width. He has CKD G4. After giving IV calcium gluconate and insulin/dextrose, potassium falls to 5.8 mmol/L. He is haemodynamically stable. What is the role of nebulised Salbutamol?

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Correct answer: C — Salbutamol 10-20 mg nebulised provides additional intracellular potassium shift (onset 15-30 min, lasts 2-4 hours) as adjunct to insulin/dextrose

Nebulised Salbutamol at high dose (10-20 mg, much higher than the bronchodilator dose of 2.5-5 mg) stimulates beta-2 receptors, activating Na+/K+-ATPase and driving potassium intracellularly. Onset is 15-30 minutes, lasting 2-4 hours. It provides additive potassium-lowering effect when combined with insulin/dextrose (~0.5-1.0 mmol/L additional reduction). It should not be used as sole therapy. Caution in patients with tachyarrhythmias or severe ischaemic heart disease.

Reference: UK Renal Association 2020 – Hyperkalaemia; NICE CG169