DOI: 10.1002/jcph.2396 ISSN: 0091-2700

A Retrospective Analysis of Intravenous Insulin versus Insulin and Nebulized Albuterol for the Treatment of Hyperkalemia in the Emergency Department

Sara N. Roach, Meghan L. Fletcher, Preeyaporn Sarangarm
  • Pharmacology (medical)
  • Pharmacology


There is limited literature evaluating nebulized albuterol in hyperkalemia management. The objective was to evaluate the efficacy of insulin alone compared to the addition of nebulized albuterol for the treatment of hyperkalemia. This is a retrospective, single‐center evaluation of adult patients with hyperkalemia at a large urban academic medical center Emergency Department. Consecutive patients with a potassium level greater than 5 mmol/L were included. Patients without a repeat potassium level within 4 hours of medication administration, those receiving hemodialysis before a repeat serum potassium, or those that had a hemolyzed blood sample were excluded. The primary outcome was the change in potassium level within 4 hours between patients who received insulin monotherapy versus insulin and albuterol. The secondary outcomes included hospital length of stay, intensive care unit admission, and mortality. Out of the 204 patients, 141 received insulin while 63 received insulin and nebulized albuterol. There was no difference in the change in potassium between the insulin versus insulin and nebulized albuterol groups (0.85±0.6 vs. 0.96±0.78 mmol/L, p = 0.36). There was no difference in median hospital length of stay (8.6 IQR 13.2 vs. 5.6 IQR 8.2 days, p = 0.09), ICU admission (31.9% vs 38.1%, p = 0.39), and all‐cause mortality (14.9% vs 17.5%, p = 0.64). In this retrospective analysis, the addition of albuterol to insulin for the treatment of hyperkalemia did not result in a greater change in potassium within 4 hours of therapy.

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