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Efficacy of Parenteral Albuterol in the Treatment of Asthma

1986; Elsevier BV; Volume: 89; Issue: 3 Linguagem: Inglês

10.1378/chest.89.3.348

1931-3543

Albert S. Rohr, Sheldon L. Spector, Gary S. Rachelefsky, Roger M. Katz, Sheldon C. Siegel,

Pharmacological Effects and Assays

Three parenteral routes of albuterol sulfate were compared with placebo in their effects on serum potassium and glucose levels, heart rate, and pulmonary function in adult asthmatic subjects. In addition, the metabolic effects of subcutaneous epinephrine were compared directly with subcutaneous albuterol. Intravenous (IV) albuterol (250 μg) caused similar decreases in serum potassium (mean 0.6±0.3 mEq/L) as 500 μg albuterol by intramuscular (IM) or subcutaneous routes. With the combined data from all three albuterol routes, glucose increases (mean 25±15 mg/dl) and heart rate increases (mean 11±6 beats/min) were clinically less important than potassium decreases. Subcutaneous epinephrine (0.3 ml, 1:1,000) gave changes in serum potassium, serum glucose, and heart rate statistically similar to those of subcutaneous albuterol (500 μg). Peak FEV, improvement (mean 61 percent) was similar with IV albuterol (250 μg), IM albuterol (500 μg) or subcutaneous albuterol (500 μg). Although the efficacy of albuterol in the doses studied was similar, the decrement in serum K+ produced was also similar and comparable to that produced by a standard dose of epinephrine. The potassium decrease may have important clinical implications. Three parenteral routes of albuterol sulfate were compared with placebo in their effects on serum potassium and glucose levels, heart rate, and pulmonary function in adult asthmatic subjects. In addition, the metabolic effects of subcutaneous epinephrine were compared directly with subcutaneous albuterol. Intravenous (IV) albuterol (250 μg) caused similar decreases in serum potassium (mean 0.6±0.3 mEq/L) as 500 μg albuterol by intramuscular (IM) or subcutaneous routes. With the combined data from all three albuterol routes, glucose increases (mean 25±15 mg/dl) and heart rate increases (mean 11±6 beats/min) were clinically less important than potassium decreases. Subcutaneous epinephrine (0.3 ml, 1:1,000) gave changes in serum potassium, serum glucose, and heart rate statistically similar to those of subcutaneous albuterol (500 μg). Peak FEV, improvement (mean 61 percent) was similar with IV albuterol (250 μg), IM albuterol (500 μg) or subcutaneous albuterol (500 μg). Although the efficacy of albuterol in the doses studied was similar, the decrement in serum K+ produced was also similar and comparable to that produced by a standard dose of epinephrine. The potassium decrease may have important clinical implications. Parenteral Adrenergic Bronchodilators and PotassiumCHESTVol. 89Issue 3PreviewThe fact that therapy with intravenously-infused epinephrine lowers the serum potassium (K+) concentration in cats has been known for more than 50 years.1 It is now well-established that the effect of catecholamines on K+ homeostasis is mediated through beta adrenoceptors, specifically, the beta2 type.2 Activated beta2 receptors stimulate the Na+-K+ pump via the activation of adenyl cyclase.3 The net result is an enhanced active transport of K+ from the extracellular to the intracellular compartment, and of Na+ in the opposite direction. Full-Text PDF