Albuterol & V-Tach

[kdietman87]

Was wondering if anyone read last month's.....JEMS, I think.....It had an article in it about how too much albuterol in a short period of time will throw pt.'s into V-Tach, even if it's just in small runs. Does anyone remember that article. I need to know where to find it, if it was last month's edition, and what magazine exactly that it was......Appreciate any help.

[AZCEP]

Check jems.com to start.

The author was referencing the hypokalemia that can happen when patients self administer albuterol for an extended period. Potassium is maintained in a pretty narrow range in the body, so small changes in either direction can cause huge problems.

Before Dustdevil weighs in, -5 for posting an ALS subject in the BLS forum.

[kdietman87]

Thanks, I'll look that up....It's killing me not being able to find the article.

[Guest]

Check jems.com to start.

The author was referencing the hypokalemia that can happen when patients self administer albuterol for an extended period. Potassium is maintained in a pretty narrow range in the body, so small changes in either direction can cause huge problems.

Before Dustdevil weighs in, -5 for posting an ALS subject in the BLS forum.

It is great that someone can actually afford the JEMs mag. and reads the article's, I cant but I thought for fun I will just spew out some lab values are 3.5 to 5.5 mmol/L this is normal range (mostly) for K+ and Albuterol can affect K levels, driving K+ into the cell (the exact physiology I can't quote of the top of my head)

But hold yer horses there AZ.

Up here in Moose-ville..... Albuterol/Salbutamol (EH) it is within scope of practice for most BLS practitioners in most provinces.

That's why Dust, (that latent Canuck) is not all over you like a fat kid on a smartie. hah.

So -40 below for azcep and did you do a spelling check yourself...hmmmm? :shock:

Just my humble opinion but it's damn hard to kill someone with Salbutomol when administered via nebuliser, and the advantages outweigh the risk by far in my mind, heck if Granny can put on the mask for Grampa why the hell not some one that can take a pulse and a B/P, or even monitor ECG....opps sorry EKG (do yalls spell it Kardiac?) :roll:

The the point you make about self administration over long periods. This is an patient education issue, if the Rescue Beta 2 is needed this frequently or if used Q4H to control bronchospasm (PS its never pleural) Then inhaled steroids should be added as a prophylaxis (can I say that here?) Steroids are believed to reduce swelling and stabilize cell membranes (the opposite to Viagra which does not reduce swelling.....off topic sorry thinking about some thing else.

Just a sidebar, an impromptu due study that was done in a facility where I worked it clearly demonstrated that MDI "metered dose inhalers" or (puffers) in ~70 % of cases evaluated were ineffective, this % increased with the aged. They just sprayed the back of the throat therefore more systemic side effects and minimal relief of wheeze.....qualifier being: without spacer's, aerochambers +++ or the like.

We... OK.....I.... developed a saying "when in doubt space them out" :roll:

OMG that ALS, squint slaps self! #-o

- 10 for wandering off topic!

[TechMedic05]

"or even monitor ECG....opps sorry EKG (do yalls spell it Kardiac?)"

I believe EKG was just adopted from the German translation of EKG: Elektrokardiogramm

I dunno, I just find it easier to say

[Guest]

"or even monitor ECG....opps sorry EKG (do yalls spell it Kardiac?)"

I believe EKG was just adopted from the German translation of EKG: Elektrokardiogramm

I dunno, I just find it easier to say

I thought they lost the war?

[TechMedic05]

eh, picky picky.

[srs911]

"Albuterol can affect K levels, driving K+ into the cell (the exact physiology I can't quote of the top of my head)"

Neither can I, but the question came up in another forum last month and I had nothing to do so I cracked a book and put this together and posted it, so will throw it out here also:

Quick answer: Albuterol causes an decrease in serum potassium levels because of its effects on the Na+/K+-ATPase pump (increases activity, more K+ into cell) and it's promotion of insulin release (increase insulin, more K+ into cells).

Detailed answer: First, albuterol shifts K+ from the extracellular space to the intracellular space by increasing Na+/K+ ATPase pump activity. Specifically, I believe that albuterol upregulates cAMP, resulting in increased pump activity. Recall from cardiology that the pump moves K+ into the cell in exchange for Na+ out of the cell; increase activity, put more K+ into the cell form the extracellular environment, serum K+ falls. Second, albuterol increases the secretion of insulin from pancreatic islet beta cells. Insulin promotes the shift of K+ into cells via activation of the normally inactive Na+/H+ exchanger (NHE) located on cell membranes. Activation of the NHE results in a K+ shift into the cell and out of the extracellular environment, serum K+ falls. That is kinda neat in that it makes intuitive sense. Think about it, you eat a banana, take in lots of K+ that would kill you if you could not redistribute and secrete it, insulin is released as a result of eating and in addition to shifting glucose into the cell it happens to also activate these two mechanisms that regulate serum K+ levels. Neat.

Hope that helps explain it.

[Ridryder 911]

Good response, and basically you also answered why Insulin and D50W is given to patients who are hyperkalemic, along with some kaexalate, this is the standard treatment.

R/R 911

[hammerpcp]

I thought they lost the war?

But they do get some credit for starting it don't they?