Salbutamol in the treatment of neonatal hyperkalemia

Neonatal hyperkalemia, a potentially life-threatening condition, is usually treated with intravenous insulin and glucose. However, this treatment can lead to hypoglycemia, which can be disastrous in newborns. In this study, we compared the effects of salbutamol and insulin plus glucose on the levels of potassium and glucose in hyperkalemic neonates. Two groups of infants, similar in age and pretreatment serum creatinine, glucose, and potassium, were studied. Group A (n = 23) received salbutamol inhalation (4 puffs, 100 μg per puff, and group B (n = 13) received insulin with glucose (0.5 g/kg/hr, with 1 unit insulin per 1-3 g glucose). Serum potassium and blood glucose were measured at 60, 120, 360 minutes after treatment. Both treatments reduced serum potassium, maximally at 60 minutes. Neonates in group A exhibited a significantly greater decrement in serum potassium, than those of group B at 60 minutes (-0.75 ± 0.14 VS -0.18 ± 0.12 mmol/L, respectively; p < 0.05). There was a maximal and significant decrement in blood glucose at 60 minutes in group B. The changes in blood glucose were -2.17 ± 4.25 and -59.38 ± 8.28 mg/dL, respectively (p < 1 x 10^-7 These observations suggest that both salbutamol and insulin with glucose effectively lower plasma potassium concentrations in hyperkalemic neonates, although salbutamol seems to inducte a more significant effect. The hypoglycemic effect of insulin is marked compared to that of salbutamol in neonates. Thus, salbutamol is an effective alternative drug for the treatment of hyperkalemia in neonates.