Original article
Nebulized salbutamol for asthma: Effects on serum potassium and phosphate levels at the 60min
Salbutamol Nebulizado na Asma: Efeitos nos níveis de Potássio e Fosfato Sérico aos 60 minutos
a Department of Emergency Medicine, Elazig Training & Education Hospital, Elazig, Turkey
b Kahraman Maras Government Hospital, Kahraman Maras, Turkey
c Department of Emergency, School of Medicine, Cukurova University, Adana, Turkey
d Department of Chest Diseases, School of Medicine, Mustafa Kemal University, Hatay, Turkey
e Department of Emergency, School of Medicine, Mustafa Kemal University, Hatay, Turkey
Read
19559
Timeswas read the article
3271
Total PDF
16288
Total HTML
Share statistics
array:24 [ "pii" => "S087321591300024X" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2012.12.003" "estado" => "S300" "fechaPublicacion" => "2013-09-01" "aid" => "139" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2013;19:200-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11936 "formatos" => array:3 [ "EPUB" => 271 "HTML" => 10126 "PDF" => 1539 ] ] "itemSiguiente" => array:20 [ "pii" => "S087321591300038X" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2013.03.004" "estado" => "S300" "fechaPublicacion" => "2013-09-01" "aid" => "153" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2013;19:204-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8266 "formatos" => array:3 [ "EPUB" => 266 "HTML" => 6159 "PDF" => 1841 ] ] "pt" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>" "titulo" => "Correlação entre função pulmonar, postura e composição corporal em pacientes com asma" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "204" "paginaFinal" => "210" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Correlation between pulmonary function, posture, and body composition in patients with asthma" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V.P. Almeida, F.S. Guimarães, V.J.R. Moço, S.L.S. Menezes, T.T. Mafort, A.J. Lopes" "autores" => array:6 [ 0 => array:2 [ "nombre" => "V.P." "apellidos" => "Almeida" ] 1 => array:2 [ "nombre" => "F.S." "apellidos" => "Guimarães" ] 2 => array:2 [ "nombre" => "V.J.R." "apellidos" => "Moço" ] 3 => array:2 [ "nombre" => "S.L.S." "apellidos" => "Menezes" ] 4 => array:2 [ "nombre" => "T.T." "apellidos" => "Mafort" ] 5 => array:2 [ "nombre" => "A.J." "apellidos" => "Lopes" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217351151300064X" "doi" => "10.1016/j.rppnen.2013.03.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151300064X?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087321591300038X?idApp=UINPBA00004E" "url" => "/08732159/0000001900000005/v3_201509041357/S087321591300038X/v3_201509041357/pt/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0873215913000585" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2012.10.006" "estado" => "S300" "fechaPublicacion" => "2013-09-01" "aid" => "160" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2013;19:192-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8864 "formatos" => array:3 [ "EPUB" => 282 "HTML" => 6415 "PDF" => 2167 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>" "titulo" => "Punção aspirativa transbrônquica guiada por ecoendoscopia brônquica no diagnóstico e estadiamento de cancro do pulmão em 179 doentes" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "192" "paginaFinal" => "199" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer diagnosis and staging in 179 patients" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1002 "Ancho" => 1500 "Tamanyo" => 165293 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Lesão periférica do lobo superior direito com estação ganglionar 2<span class="elsevierStyleHsp" style=""></span>R positiva na PET <span class="elsevierStyleBold">(A)</span>; agulha no interior de gânglio mediastínico hipoecogénico heterogéneo com dimensões aumentadas <span class="elsevierStyleBold">(B)</span>; diagnóstico citológico de adenocarcinoma do pulmão 400 x <span class="elsevierStyleBold">(C)</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Bugalho, D. Ferreira, R. Barata, C. Rodrigues, S.S. Dias, F. Medeiros, L. Carreiro" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Bugalho" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Barata" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Rodrigues" ] 4 => array:2 [ "nombre" => "S.S." "apellidos" => "Dias" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Medeiros" ] 6 => array:2 [ "nombre" => "L." "apellidos" => "Carreiro" ] ] ] ] ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000585?idApp=UINPBA00004E" "url" => "/08732159/0000001900000005/v3_201509041357/S0873215913000585/v3_201509041357/pt/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Nebulized salbutamol for asthma: Effects on serum potassium and phosphate levels at the 60<span class="elsevierStyleHsp" style=""></span>min" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "200" "paginaFinal" => "203" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Sahan, M. Yılmaz, Y. Gokel, E.S. Erden, A. Karakus" "autores" => array:5 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Sahan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Yılmaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Y." "apellidos" => "Gokel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "E.S." "apellidos" => "Erden" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:4 [ "nombre" => "A." "apellidos" => "Karakus" "email" => array:1 [ 0 => "drkarakus@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">⿿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Department of Emergency Medicine, Elazig Training & Education Hospital, Elazig, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Kahraman Maras Government Hospital, Kahraman Maras, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Emergency, School of Medicine, Cukurova University, Adana, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Chest Diseases, School of Medicine, Mustafa Kemal University, Hatay, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Emergency, School of Medicine, Mustafa Kemal University, Hatay, Turkey" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⿿" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Salbutamol Nebulizado na Asma: Efeitos nos níveis de Potássio e Fosfato Sérico aos 60 minutos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1448 "Ancho" => 1682 "Tamanyo" => 99768 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Serum phosphate levels did not decrease significantly during the treatment (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.373). Serum potassium levels decreased significantly (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Asphyxia is responsible for the majority of deaths in patients with acute asthmatic crisis, and the adverse effects of medical treatments are also important in terms of the deaths.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Nebulized β-adrenergic agonists are the mainstay of treatment for acute exacerbation of asthma in the emergency setting.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> β-Adrenergic agonists (BAA) have side effects such as tremor, palpitations, tachycardia, and anxiety.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are several studies that demonstrate a statistically significant decrease in serum potassium and magnesium after BAA administration.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4⿿7</span></a> In addition, there are also some studies regarding the BAA induced hypophosphatemia.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8⿿11</span></a> In the current research, our aim is to investigate Serum Potassium and Phosphate Levels at the 60<span class="elsevierStyleHsp" style=""></span>min after administration of Nebulized Salbutamol for Asthma.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">This prospective study is conducted in patients with asthmatic attack in the emergency department. Patients were treated with a BAA-salbutamol ⿿ according to a study protocol that was approved by the local ethical committee. Informed consent was obtained from all the patients. Baseline data including age, sex, clinical history, and the medications used were recorded. All patients included in the study met the criteria as: age >16 years, a history of acute exacerbation of asthma (dyspnea, cough and, on examination, wheezing). Patients with respiratory failure, altered mental status, renal failure, diabetes mellitus, and cirrhosis were excluded. Patients using alcohol, diuretics, theophylline, aminophylline, antidiabetic, and antihypertensive drugs were also excluded. The samples had BAA at least four hours before the admission. The severity of the exacerbation determines the treatment modality. Indices of severity including particularly PEF, pulse rate, respiratory rate, and pulse oximetry, had to be monitored during treatment. The exacerbation severity was defined according to the Global Strategy for Asthma Management and Prevention 2011.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">All the patients were monitorized by continuous electrocardiograhy, and arterial oxygen saturation by pulse oximetry with a finger oximeter. The baseline peak expiratory flow rate was measured. An intraveneous (i.v.) line for repeated blood sampling was established and baseline laboratory assay which included serum phosphate, creatinine, blood urea nitrogen, glucose, potassium levels was performed. Patients were given initial nebulized treatment of salbutamol (2.5<span class="elsevierStyleHsp" style=""></span>mg).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nebulized salbutamol (2.5<span class="elsevierStyleHsp" style=""></span>mg) was used three times during the first hour. After the third administration of salbutamol, serum phosphate and potassium levels were assessed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">None of the patient received magnesium, potassium, phosphate, corticosteroids, theophylline, and i.v. dextrose or saline during the study period.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The mean and standard deviation were calculated for baseline and subsequent measure of phosphate and potassium. Paired-<span class="elsevierStyleItalic">t</span> test was used for analyzing the changes in case of phosphate and potassium levels. <span class="elsevierStyleItalic">p</span>-Value <0.05 was considered statistically significant.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Twenty-six patients were enrolled during the study period. The mean patient age was 58.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.3 years (range 35⿿74 years), with 11 female and 15 male asthmatic patients. All the patients had moderate asthmatic attack. The protocol included the usage of oxygen if arterial oxygen saturation (Sao2) decreased to less than 92%. However, during the study, all patients had Sao2 values above 92%. There was no change in ECG monitorization related to hypokalemia in the patients. In the emergency department, all patients received three doses of nebulized salbutamol therapy (2.5<span class="elsevierStyleHsp" style=""></span>mg, every 20<span class="elsevierStyleHsp" style=""></span>min). Theophylline and corticosteroids were not administered in the emergency department during the study. Neither intraveneous dextrose nor saline solution was used during the study period.</p><p id="par0040" class="elsevierStylePara elsevierViewall">There was an average duration of symptoms of 30<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>h (range 2⿿55) before seeking medical attention. Mean baseline peak expiratory flow rate averaged 210<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>110<span class="elsevierStyleHsp" style=""></span>L/min (range 100⿿320<span class="elsevierStyleHsp" style=""></span>L/min).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although serum phosphate levels decreased from a mean of 3.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9<span class="elsevierStyleHsp" style=""></span>mg/dL at baseline to 3.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9<span class="elsevierStyleHsp" style=""></span>mg/dL at 60<span class="elsevierStyleHsp" style=""></span>min, no significant decrease was found (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Serum potassium levels decreased significantly from 4.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 (baseline) to 4.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7<span class="elsevierStyleHsp" style=""></span>mmol/L (60<span class="elsevierStyleHsp" style=""></span>min) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The aim of this study was to add more data to the information concerning the serum phosphate and potassium changes during intensive treatment of acute asthma with salbutamol.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In this study, salbutamol use was accompanied by a significant decrease in serum potassium levels. Our observation regarding BAA related hypokalemia is consistent with most of the previous studies.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4⿿7</span></a> The principal action of BAA is to stimulate the BAA that are associated with the membrane-bound sodium-potassium ATPase. Activation of this enzyme results in a direct potassium influx into cells.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In this report, salbutamol was given according to the standard emergency medical protocols, and it was not accompanied by significant decrease in serum phosphate. Serum phosphate levels decreased from a mean of 3.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9<span class="elsevierStyleHsp" style=""></span>mg/dL at baseline to 3.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9<span class="elsevierStyleHsp" style=""></span>mg/dL at 60<span class="elsevierStyleHsp" style=""></span>min. No significant correlation was found. This result is not consistent with previous studies.</p><p id="par0070" class="elsevierStylePara elsevierViewall">There are some differences between our study and previous studies. Firstly, we administered only a BAA-salbutamol. We did not use i.v. fluids, theophylline, and corticosteroids which may have an effect on serum phosphate levels.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Secondly, our patients were not receiving theophylline, diuretics, antihypertensive, and antidiabetics before they arrived at the emergency department.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In one study BAA induced hypophosphatemia, but BAA and other bronchodilator drugs were used together.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In a different study, BAA decreased serum phosphate, besides albuterol, other bronchodilator agents such as theophylline, atropin, corticosteroids, and i.v. fluids were administered.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In another study, it is reported that hypophosphatemia induced by albuterol is due to the parenteral albuterol administration.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In Massara et al's study, i.v. infusion of salbutamol caused hypophosphatemia.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In the current study, we used only nebulized salbutamol. Other drugs that may affect serum phosphate levels such as theophylline, corticosteroids and IV fluids were not used. Therefore, this preliminary report indicates that a further study aimed at elucidating the clinical effect of nebulized salbutamol on serum phosphate is required.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of human and animal subjects</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres547662" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec565543" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres547663" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiais e métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec565542" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-09-07" "fechaAceptado" => "2012-12-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565543" "palabras" => array:3 [ 0 => "Salbutamol" 1 => "Phosphate" 2 => "Asthma" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec565542" "palabras" => array:3 [ 0 => "Salbutamol" 1 => "Fosfato" 2 => "Asma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We conducted this prospective study to expand available information in relation to serum phosphate levels in treatment of acute asthma. A β-adrenergic agonist, salbutamol, was used for this purpose.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Twenty-six patients who met the inclusion criteria as; age over 16 years, asthma history, and an acute exacerbation were included. Serum blood urea nitrogen, creatinine, glucose were within normal limits in all the patients. None of the patients were on chronic theophylline therapy. Baseline serum phosphate and potassium levels were measured. Nebulized salbutamol (2.5<span class="elsevierStyleHsp" style=""></span>mg) was used three times at every hour. After 60<span class="elsevierStyleHsp" style=""></span>min, serum phosphate and potassium levels were measured.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Serum phosphate levels decreased from 3.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9<span class="elsevierStyleHsp" style=""></span>mg/dL (baseline) to 3.6±0.9<span class="elsevierStyleHsp" style=""></span>mg/dL at 60<span class="elsevierStyleHsp" style=""></span>min. This decrease was not statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.373). Serum potassium levels decreased significantly (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) from 4.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7<span class="elsevierStyleHsp" style=""></span>mmol/L (baseline) to 4.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7<span class="elsevierStyleHsp" style=""></span>mmol/L (60<span class="elsevierStyleHsp" style=""></span>min).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Administration of nebulized salbutamol during the emergency treatment of acute exacerbation of asthma is not associated with a statistical decrease in serum phosphate. There was significant hypokalemia. This study indicates that a further study is needed to elucidate the clinical significance of nebulized salbutamol on serum phosphate.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Levámos a cabo este estudo prospetivo para ampliar a informação disponível relativamente aos níveis de fosfato sérico no tratamento de asma aguda. Foi utilizado um agonista β-adrenérgico, salbutamol, para este efeito.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiais e métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram incluídos 26 doentes que cumpriam os critérios de inclusão de: idade superior a 16 anos, história de asma, incluindo uma exacerbação aguda. A ureia do soro sanguíneo, creatinina e glucose estavam nos limites normais em todos os doentes. Nenhum dos doentes era submetido a terapia crónica de teofilina. Os níveis da base de referência de fosfato e potássio sérico foram medidos. O nebulizador de salbutamol (2,5<span class="elsevierStyleHsp" style=""></span>mg) era usado 3 vezes por hora. Após 60 min, os níveis da base de referência de fosfato e potássio sérico eram medidos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os níveis de fosfato sérico diminuíram de 3,7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,9<span class="elsevierStyleHsp" style=""></span>mg/dL (base de referência) para 3,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,9<span class="elsevierStyleHsp" style=""></span>mg/dL aos 60 min. Esta redução não era estatisticamente significativa (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,373). Os níveis de potássio sérico diminuíram significativamente (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001) de 4,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,7<span class="elsevierStyleHsp" style=""></span>mmol/L (base de referência) para 4,3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,7<span class="elsevierStyleHsp" style=""></span>mmol/L aos 60 min.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusão</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A administração de salbutamol nebulizado durante o tratamento de urgência de uma exacerbação aguda de asma não está associada a uma diminuição estatística do fosfato sérico. Ocorreu uma hipocalemia significativa. Este estudo indica que é necessário um estudo adicional para esclarecer o significado clínico do salbutamol nebulizado no fosfato sérico.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiais e métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1448 "Ancho" => 1682 "Tamanyo" => 99768 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Serum phosphate levels did not decrease significantly during the treatment (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.373). Serum potassium levels decreased significantly (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory arrest in near fatal asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.A. Malfino" 1 => "L.J. Nannini" 2 => "A.N. Martelli" 3 => "A.S. Slutsky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199101313240502" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1991" "volumen" => "324" "paginaInicial" => "285" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1986288" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequency of inhaled metaproterenol in the treatment of acute asthma exacerbation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.N. Nelson" 1 => "A. Hofstadter" 2 => "J. Parker" 3 => "C. Hargis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "1990" "volumen" => "19" "paginaInicial" => "21" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2297150" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchodilator therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.C. Webb-Johnson" 1 => "J.L. Andrews" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM197709012970905" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "1977" "volumen" => "297" "paginaInicial" => "476" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/69991" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204501005010" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypokalemia induced by bronchodilators" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.M. Gelmont" 1 => "J.R. Balmes" 2 => "A. Yee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1988" "volumen" => "94" "paginaInicial" => "763" "paginaFinal" => "766" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3168573" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic and cardiovascular side effects of the β-2 adrenoceptor agonists salbutamol and rimiterol" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.J. Phillips" 1 => "A.E. Vedig" 2 => "P.L. Jones" 3 => "M.G. Chapman" 4 => "M. Collins" 5 => "J.B. Edwards" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Clin Pharmacol" "fecha" => "1980" "volumen" => "9" "paginaInicial" => "483" "paginaFinal" => "491" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6104976" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypokalemia from β-2 receptor stimulation by circulating epinephrine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Brown" 1 => "D.C. Brown" 2 => "M.B. Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198312083092303" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1983" "volumen" => "309" "paginaInicial" => "1414" "paginaFinal" => "1419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6314140" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum potassium responses to nebulized salbutamol administered during an acute asthmatic attack" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. DaCruz" 1 => "C. Holburn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Emerg Med" "fecha" => "1989" "volumen" => "6" "paginaInicial" => "22" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2712984" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypophosphatemia complicating bronchodilator therapy for acute severe asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.R. Brady" 1 => "F. Ryan" 2 => "J. Cunningham" 3 => "W. Tormey" 4 => "M.P. Ryan" 5 => "S. O⿿Neill" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1989" "volumen" => "149" "paginaInicial" => "2367" "paginaFinal" => "2368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2802903" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic effects of salbutamol: comparison of aerosol and intravenous administration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Neville" 1 => "J.B. Palmer" 2 => "J. Gaddie" 3 => "C.S. May" 4 => "K.N. Palmer" 5 => "L.E. Murchison" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br Med J" "fecha" => "1977" "volumen" => "1" "paginaInicial" => "413" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/761042" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Some metabolic and hormonal effects of salbutamol in man" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Masara" 1 => "V. Fassio" 2 => "F. Camanni" 3 => "V. Martina" 4 => "G. Molinatti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Diabetol Lat" "fecha" => "1976" "volumen" => "13" "paginaInicial" => "146" "paginaFinal" => "153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1020612" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequently nebulized β-agonists for asthma: effects on serum electrolytes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Bodenhamer" 1 => "R. Bergstrom" 2 => "D. Brown" 3 => "P. Gabow" 4 => "J.A. Marx" 5 => "S.R. Lowenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "1992" "volumen" => "21" "paginaInicial" => "53" "paginaFinal" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1539888" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508505022766" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Strategy for Asthma Management and Prevention 2011 (update) (<a href="http://www.ginasthma.org/">www.ginasthma.org</a>), p. 72." ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Albuterol: an adrenergic agent for use in the treatment of asthma phamacology, pharmacokinetics and clinical use" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.C. Ahrens" 1 => "G.D. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pharmacotherapy" "fecha" => "1984" "volumen" => "4" "paginaInicial" => "105" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6739311" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000001900000005/v3_201509041357/S087321591300024X/v3_201509041357/en/main.assets" "Apartado" => array:4 [ "identificador" => "9575" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Artigos originais" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001900000005/v3_201509041357/S087321591300024X/v3_201509041357/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087321591300024X?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 34 | 10 | 44 |
| 2024 October | 230 | 46 | 276 |
| 2024 September | 283 | 22 | 305 |
| 2024 August | 301 | 31 | 332 |
| 2024 July | 385 | 39 | 424 |
| 2024 June | 257 | 44 | 301 |
| 2024 May | 241 | 48 | 289 |
| 2024 April | 243 | 46 | 289 |
| 2024 March | 202 | 32 | 234 |
| 2024 February | 196 | 28 | 224 |
| 2024 January | 143 | 25 | 168 |
| 2023 December | 222 | 37 | 259 |
| 2023 November | 262 | 47 | 309 |
| 2023 October | 190 | 54 | 244 |
| 2023 September | 207 | 43 | 250 |
| 2023 August | 120 | 36 | 156 |
| 2023 July | 89 | 31 | 120 |
| 2023 June | 89 | 24 | 113 |
| 2023 May | 77 | 33 | 110 |
| 2023 April | 46 | 23 | 69 |
| 2023 March | 109 | 30 | 139 |
| 2023 February | 63 | 21 | 84 |
| 2023 January | 37 | 23 | 60 |
| 2022 December | 57 | 15 | 72 |
| 2022 November | 74 | 42 | 116 |
| 2022 October | 56 | 27 | 83 |
| 2022 September | 34 | 36 | 70 |
| 2022 August | 48 | 48 | 96 |
| 2022 July | 45 | 46 | 91 |
| 2022 June | 38 | 29 | 67 |
| 2022 May | 55 | 36 | 91 |
| 2022 April | 44 | 39 | 83 |
| 2022 March | 33 | 43 | 76 |
| 2022 February | 29 | 34 | 63 |
| 2022 January | 42 | 43 | 85 |
| 2021 December | 21 | 37 | 58 |
| 2021 November | 31 | 31 | 62 |
| 2021 October | 37 | 44 | 81 |
| 2021 September | 24 | 26 | 50 |
| 2021 August | 29 | 18 | 47 |
| 2021 July | 31 | 19 | 50 |
| 2021 June | 45 | 26 | 71 |
| 2021 May | 61 | 31 | 92 |
| 2021 April | 164 | 63 | 227 |
| 2021 March | 129 | 12 | 141 |
| 2021 February | 69 | 16 | 85 |
| 2021 January | 57 | 20 | 77 |
| 2020 December | 58 | 3 | 61 |
| 2020 November | 66 | 18 | 84 |
| 2020 October | 53 | 10 | 63 |
| 2020 September | 79 | 16 | 95 |
| 2020 August | 88 | 27 | 115 |
| 2020 July | 109 | 24 | 133 |
| 2020 June | 96 | 19 | 115 |
| 2020 May | 118 | 23 | 141 |
| 2020 April | 103 | 12 | 115 |
| 2020 March | 83 | 18 | 101 |
| 2020 February | 89 | 25 | 114 |
| 2020 January | 102 | 20 | 122 |
| 2019 December | 101 | 32 | 133 |
| 2019 November | 116 | 17 | 133 |
| 2019 October | 99 | 27 | 126 |
| 2019 September | 94 | 30 | 124 |
| 2019 August | 211 | 10 | 221 |
| 2019 July | 240 | 16 | 256 |
| 2019 June | 251 | 23 | 274 |
| 2019 May | 326 | 31 | 357 |
| 2019 April | 221 | 19 | 240 |
| 2019 March | 223 | 14 | 237 |
| 2019 February | 199 | 19 | 218 |
| 2019 January | 249 | 27 | 276 |
| 2018 December | 166 | 11 | 177 |
| 2018 November | 47 | 0 | 47 |
| 2018 October | 90 | 13 | 103 |
| 2018 September | 66 | 8 | 74 |
| 2018 August | 45 | 48 | 93 |
| 2018 July | 47 | 29 | 76 |
| 2018 June | 63 | 23 | 86 |
| 2018 May | 69 | 30 | 99 |
| 2018 April | 83 | 22 | 105 |
| 2018 March | 109 | 32 | 141 |
| 2018 February | 31 | 26 | 57 |
| 2018 January | 33 | 20 | 53 |
| 2017 December | 47 | 23 | 70 |
| 2017 November | 54 | 16 | 70 |
| 2017 October | 30 | 22 | 52 |
| 2017 September | 42 | 14 | 56 |
| 2017 August | 39 | 19 | 58 |
| 2017 July | 29 | 19 | 48 |
| 2017 June | 49 | 19 | 68 |
| 2017 May | 43 | 23 | 66 |
| 2017 April | 20 | 5 | 25 |
| 2017 March | 28 | 58 | 86 |
| 2017 February | 12 | 10 | 22 |
| 2017 January | 22 | 6 | 28 |
| 2016 December | 16 | 9 | 25 |
| 2016 November | 14 | 9 | 23 |
| 2016 October | 29 | 9 | 38 |
| 2016 September | 17 | 6 | 23 |
| 2016 August | 9 | 7 | 16 |
| 2016 July | 8 | 6 | 14 |
| 2016 June | 4 | 9 | 13 |
| 2016 May | 19 | 10 | 29 |
| 2016 April | 158 | 1 | 159 |
| 2016 March | 218 | 18 | 236 |
| 2016 February | 209 | 28 | 237 |
| 2016 January | 220 | 23 | 243 |
| 2015 December | 225 | 22 | 247 |
| 2015 November | 239 | 28 | 267 |
| 2015 October | 247 | 23 | 270 |
| 2015 September | 266 | 25 | 291 |
| 2015 August | 179 | 21 | 200 |
| 2015 July | 238 | 15 | 253 |
| 2015 June | 214 | 14 | 228 |
| 2015 May | 202 | 16 | 218 |
| 2015 April | 232 | 22 | 254 |
| 2015 March | 217 | 5 | 222 |
| 2015 February | 207 | 11 | 218 |
| 2015 January | 187 | 14 | 201 |
| 2014 December | 170 | 18 | 188 |
| 2014 November | 221 | 21 | 242 |
| 2014 October | 266 | 16 | 282 |
| 2014 September | 268 | 24 | 292 |
| 2014 August | 229 | 18 | 247 |
| 2014 July | 228 | 29 | 257 |
| 2014 June | 202 | 22 | 224 |
| 2014 May | 176 | 14 | 190 |
| 2014 April | 163 | 18 | 181 |
| 2014 March | 203 | 20 | 223 |
| 2014 February | 126 | 17 | 143 |
| 2014 January | 152 | 21 | 173 |
| 2013 December | 129 | 36 | 165 |
| 2013 November | 113 | 43 | 156 |
| 2013 October | 94 | 53 | 147 |
| 2013 September | 57 | 20 | 77 |
Show all
