Welcome to UH EMS-I’s Pharmacy Phriday. This week, we’ll review albuterol, a common medication administered in conjunction with ipratropium as an aerosol in respiratory cases. Within the UH drug boxes, albuterol is also provided as a stand-alone medication. One of the indications for its use is the first-line medication in pediatric patients experiencing mild distress from a lower airway emergency. Another indication for its use is in cases of hyperkalemia.
Hyperkalemia is a condition characterized by an excessive amount of potassium in the blood. Potassium assists in maintaining a regular heart rate, maintaining fluid balance, and allowing the nerves and muscles to work properly. The kidneys are the main organ that controls the correct level of potassium in the blood. In cases where kidney function is impaired or excessive potassium is present in the body, hyperkalemia can result. Some of these causes might include acute or chronic kidney failure, kidney disease, missed dialysis, use of certain medications, trauma, or excessive diet intake of potassium, to name a few.
When hyperkalemia exists, a patient may experience symptoms of muscle weakness, numbness or tingling in the arms, dizziness, chest pain, shortness of breath, or cardiac complaints. A classic sign the provider can observe is ECG changes that include peaked T waves, the loss of P waves, a widening QRS, and, in extreme cases, sine waves or asystole.
The treatment in hyperkalemia is focused on stabilizing cardiac membranes (thus the use of calcium as discussed in last week’s installment), to redistribute potassium from the bloodstream into the cells (this is where albuterol comes in for us), and eliminate the potassium from the body (i.e., medications that exchange potassium for other electrolytes or dialysis).
The role that albuterol plays in this treatment goal is not the bronchodilation effect we think of in respiratory cases, but in its ability to stimulate the sodium-potassium pump, causing potassium to shift into the cellular space. This cellular uptake of potassium leads to a decrease in its concentration in the blood. The onset of action for the medication is typically within 30 minutes. The effect is temporary, but beneficial until more advanced treatments can be provided within the ED and hospital settings.
The dosing of albuterol in cases of hyperkalemia is much higher than that in respiratory cases and is listed as a starting dose of 10 mg, which equals four of the aerosol treatments provided in the UH drug boxes (2.5 mg/3 ml). The albuterol aerosols should be started as soon as possible and, in most cases, continued throughout transport. Once again, this treatment is combined with others, including calcium, and in severe cases (i.e., the presence of a wide QRS or sine waves), sodium bicarbonate.
Due to the high doses used and the potential beta1-receptor stimulation, patients may experience tachycardia. Other side effects can include tremors, palpitations, anxiety, and headaches. Mild hyperglycemia has also been reported.
A key point to highlight regarding the administration of albuterol in these circumstances is the fact that, under the UH protocols, the medication can only be given by the advanced-level EMT or paramedic for these cases.
Until our next edition, stay safe!
Until next time, stay safe!
Sincerely,
The UH EMS-I Team
University Hospitals
Download a PDF of this email HERE.