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Abstract
A short cut review was carried out to establish whether nebulised levalbuterol is better than or equivalent to albuterol for lowering serum potassium. Seven papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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Report by Herald Ostovar, Senior EM Resident Checked by Dr Jeffrey Jones, Research Director of the Emergency Medicine Residency Program and Dr Michael Brown, Director of the Emergency Medicine Residency Program
Three part question
In [patients with hyperkalaemia] is [levalbuterol better than albuterol] at reducing [serum potassium]?
Clinical scenario
A 67 year old man presents to the emergency department with chest pain and syncope. The electrocardiogram shows a wide QRS and peaked T-waves. Stat electrolytes show a potassium level of 7.3. While starting calcium gluconate, glucose/insulin, nebulised albuterol and kayexelate you wonder if substitution of levalbuterol for albuterol would have the same lowering effect on serum potassium and have fewer side effects.
Search strategy
Medline 1966–October 2004 using the OVID interface. [levalbuterol.mp or exp Albuterol/OR (albuterol or salbutamol).mp OR exp bronchodilator agents/OR exp adrenergic beta-agonists/OR beta-agonists.mp] AND [exp stereoisomerism/OR enantiomers.mp OR racemic.mp] AND [hyperkalemia.mp. or exp hyperkalemia/OR hyperkalaemia.mp OR exp potassium] LIMIT to human AND English language
Search outcome
Seven papers were found of which three were irrelevant to the study question. The remaining four papers are shown in table 3.
Comment
Equipotent nebulised levalbuterol appears to be as effective as albuterol in lowering serum potassium in healthy and asthmatic adults. Studies comparing these two medications in hyperkalaemic patients with comorbidities and on various medications would be helpful in establishing their comparative efficacy in treating common presenters to the emergency department.
CLINICAL BOTTOM LINE
Nebulised levalbuterol appears to be as effective as albuterol in lowering serum potassium in adults.
Report by Herald Ostovar, Senior EM Resident Checked by Dr Jeffrey Jones, Research Director of the Emergency Medicine Residency Program and Dr Michael Brown, Director of the Emergency Medicine Residency Program