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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
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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" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000730?idApp=UINPBA00004E" "url" => "/21735115/0000001900000005/v3_201405231121/S2173511513000730/v3_201405231121/en/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" => 1426 "Ancho" => 1681 "Tamanyo" => 94070 ] ] "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:2 [ "identificador" => "xres341252" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Material and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec322992" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres341253" "titulo" => array:5 [ 0 => "Resumo" 1 => "Objetivo" 2 => "Materiais e métodos" 3 => "Resultados" 4 => "Conclusão" ] ] 3 => array:2 [ "identificador" => "xpalclavsec322991" "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" => "xpalclavsec322992" "palabras" => array:3 [ 0 => "Salbutamol" 1 => "Phosphate" 2 => "Asthma" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec322991" "palabras" => array:3 [ 0 => "Salbutamol" 1 => "Fosfato" 2 => "Asma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<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 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 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 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>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<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 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 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 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>" ] ] "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" => 1426 "Ancho" => 1681 "Tamanyo" => 94070 ] ] "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. 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