EFICACIA DEL SALBUTAMOL VÍA INTRAVENOSA vs. VÍA MICRONEBULIZADOR PARA EL TRATAMIENTO DE LA HIPERKALEMIA AGUDA EN EL PACIENTE CON INSUFICIENCIA RENAL CRÓNICA SIN TRATAMIENTO SUSTITUTIVO

Abstract

Chronic renal failure (CRF) is defined as the gradual loss, permanent and irreversible glomerular filtration rate with consequent clinical syndrome resulting from kidney failure to carry out cleansing duties, excretory, endocrine and metabolic regulators. Called uremic patients are able to maintain potassium in the normal range until there is oliguria or glomerular filtration rate falls below 5 ml / min. A common finding is the detection in blood tests of high concentrations of K. In this case the electrolyte disturbance may occur from cardiac arrhythmias to cardiopulmonary arrest. For the treatment of hyperkalemia first-line drugs are the beta2-agonists such as salbutamol to mediate intracellular uptake of potassium and that given its efficacy and safety and can be used intravenously or micronebulization, although there are few reported studies on this. OBJECTIVE :Identify, assess and quantify the effectiveness of the treatment of hyperkalemia with salbutamol in patients with chronic renal insufficiency without replacement therapy on renal function through both routes of administration and to compare the presented effects in both cases. The show will allow us to decrease the effectiveness of using micro-nebulization equipment, reducing equipment costs, cleaning and sterilizing them and in turn offer more appropriate treatment to patients. MATERIAL AND METHODS : This study describes a randomized clinical trial. The population was composed of adult patients aged 18 to 90 who entered the adult emergency area HGZ 1 A IMSS, carriers of chronic renal failure (CRF) that do not carry replacement therapy on renal function and whose first serum potassium determinations are greater than 5.5 mEq / dL. Were handled in two treatment groups: the first will administer intravenous salbutamol, an ampoule of 0.5 mg diluted in 100 ml of sol glucusada 5%, to infuse for 15 min. The second group received salbutamol via micronebulizador (2 ml of the solution to micronebulizador equivalent to 10 mg of salbutamol) for 15 min, ie 10 mg diluted in 2 ml solution for injection inhaled by mask. Identify the serum potassium concentration at 60 min after the start of treatment by both routes, and questioned the presence of side effects of drug administration. The data obtained through record sheets will be analyzed through descriptive statistics, with mean and standard deviation for quantitative variables, percentages for qualitative variables. To assess differences between groups, will be used ANOVA or Kruskal Wallis, as appropriate, shall be considered significant (p ≤ 0.05). To evaluate the difference between qualitative variables used х2 Chi 2 or Fisher. The analysis is performed using SPSS 15.0. RESULTS In our study we observed that the effect of salbutamol administered via intravenous micro-nebulization and with respect to the decrease in serum potassium on admission and after treatment was statistically significant at p <0.004, determining that the treatment is effective. But there was no statistical significance between the mean of the two groups after treatment (p = 0.1). Side effects reported 21.2% had tachycardia after administration of salbutamol, 12.1% to 9.1% and micronebulizador route for intravenous administration. It was reported headache on the way micronebulizador group and only 3% had headache after the administration of salbutamol intravenously. The 7.6% with dizziness after the administration of salbutamol, 4.5% to 3.1% and micronebulizador route for intravenous administration. CONCLUSIONS :For the results obtained in this study can conclude that the administration of salbutamol as a treatment for lowering serum potassium in patients with renal failure without replacement therapy in renal function is effective, being equally to both forms of administration . Side effects are minor compared submitted to the consequence of presenting a lethal arrhythmia. Finding unlike the previously reported in the literature that the effect of tachycardia was presented mostly in the group that was administered via micro-nebulization salbultamol. As we conclude that both routes of administration are safe.