title: Special Comments - Neonatal Intensive Care Drug Manual
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  Neonatal Intensive Care Drug Manual
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  bet | 546/654 | Sana | 03.01.2022 | Hajmi | 1,5 Mb. | | #14803 |
  Special Comments
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  Cross-check the correct strength of salbutamol intravenous and inhalation ampoules.
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  Evidence summary
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  Efficacy and safety
  Treatment of hyperkalaemia: A systematic review identified one study (Singh et al., 2002) of 19 infants which compared inhaled salbutamol [albuterol] versus placebo for non-oliguric hyperkalaemia (serum K+ 5–7.5 mmol/L) in premature newborns.1 Inhaled salbutamol 400 microgram, repeated 2-hourly as required, reduced serum K+ from baseline at 4 hours (mean difference 0.69 mmol/L) and 8 hours (mean difference 0.59 mmol/L).1 All-cause mortality was not reduced and cardiac arrhythmia did not occur in either study group.
  There was no significant difference in severe IVH, tremor, hyperglycaemia or pulmonary haemorrhage.1
  A number of case reports and case series have been published documenting the efficacy of salbutamol by infusion for treatment of hyperkalaemia in the newborn. Greenhough et al reported the use of IV salbutamol 4 microgram/kg over 20 minutes in 10 consecutive neonates with hyperkalaemia.2 The potassium fell in 7 of the 10 infants (range 0.7–1.8 mmol/L) but continued to rise in 3 infants, all of whom had a persistent metabolic acidosis.2
  Murdoch et al reported on the use of IV salbutamol 4 microgram/kg over 20 minutes in 13 children (ages 0.01–16.7 years) with hyperkalaemia.3 The mean reduction in plasma potassium concentration was 1.48 mmol/L at 40 minutes and 1.64 mmol/L at 120 minutes.3
  Kemper et al reported on the use of IV salbutamol at 5 microgram/kg over 20 minutes in 15 children (ages 0.1–16 years) with hyperkalaemia.4 The mean reduction in plasma potassium concentration was 0.87 mmol/L at 30 minutes and 1.69 mmol/L at 120 minutes. Transient tachycardia was detected in three patients.4
  Recommendation: Salbutamol (either inhaled or intravenously administered) may be used in the treatment of hyperkalaemia in the neonate. Salbutamol may be useful in settings where hypoglycaemia limits the use of insulin. Salbutamol may have additive effects when used with insulin and glucose. Salbutamol appears to be generally safe with limited risk of tachycardia. (LOE II – II GOR B).
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