array:24 [
  "pii" => "S2173511513000742"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2013.10.006"
  "estado" => "S300"
  "fechaPublicacion" => "2013-09-01"
  "aid" => "139"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2012"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "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" => 3558
    "formatos" => array:3 [
      "EPUB" => 246
      "HTML" => 2524
      "PDF" => 788
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S217351151300064X"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2013.03.005"
    "estado" => "S300"
    "fechaPublicacion" => "2013-09-01"
    "aid" => "153"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "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" => 7274
      "formatos" => array:3 [
        "EPUB" => 267
        "HTML" => 5419
        "PDF" => 1588
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Correlation between pulmonary function&#44; posture&#44; and body composition in patients with asthma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "204"
          "paginaFinal" => "210"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Correla&#231;&#227;o entre fun&#231;&#227;o pulmonar&#44; postura e composi&#231;&#227;o corporal em pacientes com asma"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "V&#46;P&#46; Almeida, F&#46;S&#46; Guimar&#227;es, V&#46;J&#46;R&#46; Mo&#231;o, S&#46;L&#46;S&#46; Menezes, T&#46;T&#46; Mafort, A&#46;J&#46; Lopes"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "V&#46;P&#46;"
              "apellidos" => "Almeida"
            ]
            1 => array:2 [
              "nombre" => "F&#46;S&#46;"
              "apellidos" => "Guimar&#227;es"
            ]
            2 => array:2 [
              "nombre" => "V&#46;J&#46;R&#46;"
              "apellidos" => "Mo&#231;o"
            ]
            3 => array:2 [
              "nombre" => "S&#46;L&#46;S&#46;"
              "apellidos" => "Menezes"
            ]
            4 => array:2 [
              "nombre" => "T&#46;T&#46;"
              "apellidos" => "Mafort"
            ]
            5 => array:2 [
              "nombre" => "A&#46;J&#46;"
              "apellidos" => "Lopes"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S087321591300038X"
        "doi" => "10.1016/j.rppneu.2013.03.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087321591300038X?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151300064X?idApp=UINPBA00004E"
    "url" => "/21735115/0000001900000005/v3_201405231121/S217351151300064X/v3_201405231121/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511513000730"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2013.10.005"
    "estado" => "S300"
    "fechaPublicacion" => "2013-09-01"
    "aid" => "160"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "ret"
    "cita" => "Rev Port Pneumol. 2013;19:R2-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3331
      "formatos" => array:3 [
        "EPUB" => 220
        "HTML" => 1777
        "PDF" => 1334
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "RETRACTED&#58; Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer diagnosis and staging in 179 patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "R2"
          "paginaFinal" => "R9"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Bugalho, D&#46; Ferreira, R&#46; Barata, C&#46; Rodrigues, S&#46;S&#46; Dias, F&#46; Medeiros, L&#46; Carreiro"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Bugalho"
            ]
            1 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Ferreira"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Barata"
            ]
            3 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Rodrigues"
            ]
            4 => array:2 [
              "nombre" => "S&#46;S&#46;"
              "apellidos" => "Dias"
            ]
            5 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Medeiros"
            ]
            6 => array:2 [
              "nombre" => "L&#46;"
              "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&#58; 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&#46; Sahan, M&#46; Y&#305;lmaz, Y&#46; Gokel, E&#46;S&#46; Erden, A&#46; Karakus"
        "autores" => array:5 [
          0 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Sahan"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Y&#305;lmaz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Y&#46;"
            "apellidos" => "Gokel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "E&#46;S&#46;"
            "apellidos" => "Erden"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Karakus"
            "email" => array:1 [
              0 => "drkarakus&#64;yahoo&#46;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&#44; Elazig Training &#38; Education Hospital&#44; Elazig&#44; Turkey"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Kahraman Maras Government Hospital&#44; Kahraman Maras&#44; Turkey"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Emergency&#44; School of Medicine&#44; Cukurova University&#44; Adana&#44; Turkey"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Department of Chest Diseases&#44; School of Medicine&#44; Mustafa Kemal University&#44; Hatay&#44; Turkey"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Department of Emergency&#44; School of Medicine&#44; Mustafa Kemal University&#44; Hatay&#44; Turkey"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Salbutamol Nebulizado na Asma&#58; Efeitos nos n&#237;veis de Pot&#225;ssio e Fosfato S&#233;rico 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 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;373&#41;&#46; Serum potassium levels decreased significantly &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</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&#44; and the adverse effects of medical treatments are also important in terms of the deaths&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Nebulized &#946;-adrenergic agonists are the mainstay of treatment for acute exacerbation of asthma in the emergency setting&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> &#946;-Adrenergic agonists &#40;BAA&#41; have side effects such as tremor&#44; palpitations&#44; tachycardia&#44; and anxiety&#46;<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&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> In addition&#44; there are also some studies regarding the BAA induced hypophosphatemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;11</span></a> In the current research&#44; 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&#46;</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&#46; Patients were treated with a BAA-salbutamol &#8211; according to a study protocol that was approved by the local ethical committee&#46; Informed consent was obtained from all the patients&#46; Baseline data including age&#44; sex&#44; clinical history&#44; and the medications used were recorded&#46; All patients included in the study met the criteria as&#58; age &#62;16 years&#44; a history of acute exacerbation of asthma &#40;dyspnea&#44; cough and&#44; on examination&#44; wheezing&#41;&#46; Patients with respiratory failure&#44; altered mental status&#44; renal failure&#44; diabetes mellitus&#44; and cirrhosis were excluded&#46; Patients using alcohol&#44; diuretics&#44; theophylline&#44; aminophylline&#44; antidiabetic&#44; and antihypertensive drugs were also excluded&#46; The samples had BAA at least four hours before the admission&#46; The severity of the exacerbation determines the treatment modality&#46; Indices of severity including particularly PEF&#44; pulse rate&#44; respiratory rate&#44; and pulse oximetry&#44; had to be monitored during treatment&#46; The exacerbation severity was defined according to the Global Strategy for Asthma Management and Prevention 2011&#46;<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&#44; and arterial oxygen saturation by pulse oximetry with a finger oximeter&#46; The baseline peak expiratory flow rate was measured&#46; An intraveneous &#40;i&#46;v&#46;&#41; line for repeated blood sampling was established and baseline laboratory assay which included serum phosphate&#44; creatinine&#44; blood urea nitrogen&#44; glucose&#44; potassium levels was performed&#46; Patients were given initial nebulized treatment of salbutamol &#40;2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nebulized salbutamol &#40;2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#41; was used three times during the first hour&#46; After the third administration of salbutamol&#44; serum phosphate and potassium levels were assessed&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">None of the patient received magnesium&#44; potassium&#44; phosphate&#44; corticosteroids&#44; theophylline&#44; and i&#46;v&#46; dextrose or saline during the study period&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The mean and standard deviation were calculated for baseline and subsequent measure of phosphate and potassium&#46; Paired-<span class="elsevierStyleItalic">t</span> test was used for analyzing the changes in case of phosphate and potassium levels&#46; <span class="elsevierStyleItalic">p</span>-Value &#60;0&#46;05 was considered statistically significant&#46;</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&#46; The mean patient age was 58&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;3 years &#40;range 35&#8211;74 years&#41;&#44; with 11 female and 15 male asthmatic patients&#46; All the patients had moderate asthmatic attack&#46; The protocol included the usage of oxygen if arterial oxygen saturation &#40;Sao2&#41; decreased to less than 92&#37;&#46; However&#44; during the study&#44; all patients had Sao2 values above 92&#37;&#46; There was no change in ECG monitorization related to hypokalemia in the patients&#46; In the emergency department&#44; all patients received three doses of nebulized salbutamol therapy &#40;2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#44; every 20<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; Theophylline and corticosteroids were not administered in the emergency department during the study&#46; Neither intraveneous dextrose nor saline solution was used during the study period&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">There was an average duration of symptoms of 30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>h &#40;range 2&#8211;55&#41; before seeking medical attention&#46; Mean baseline peak expiratory flow rate averaged 210<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>110<span class="elsevierStyleHsp" style=""></span>L&#47;min &#40;range 100&#8211;320<span class="elsevierStyleHsp" style=""></span>L&#47;min&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although serum phosphate levels decreased from a mean of 3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL at baseline to 3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL at 60<span class="elsevierStyleHsp" style=""></span>min&#44; no significant decrease was found &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Serum potassium levels decreased significantly from 4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 &#40;baseline&#41; to 4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L &#40;60<span class="elsevierStyleHsp" style=""></span>min&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</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&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In this study&#44; salbutamol use was accompanied by a significant decrease in serum potassium levels&#46; Our observation regarding BAA related hypokalemia is consistent with most of the previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> The principal action of BAA is to stimulate the BAA that are associated with the membrane-bound sodium-potassium ATPase&#46; Activation of this enzyme results in a direct potassium influx into cells&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In this report&#44; salbutamol was given according to the standard emergency medical protocols&#44; and it was not accompanied by significant decrease in serum phosphate&#46; Serum phosphate levels decreased from a mean of 3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL at baseline to 3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL at 60<span class="elsevierStyleHsp" style=""></span>min&#46; No significant correlation was found&#46; This result is not consistent with previous studies&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">There are some differences between our study and previous studies&#46; Firstly&#44; we administered only a BAA-salbutamol&#46; We did not use i&#46;v&#46; fluids&#44; theophylline&#44; and corticosteroids which may have an effect on serum phosphate levels&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Secondly&#44; our patients were not receiving theophylline&#44; diuretics&#44; antihypertensive&#44; and antidiabetics before they arrived at the emergency department&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In one study BAA induced hypophosphatemia&#44; but BAA and other bronchodilator drugs were used together&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In a different study&#44; BAA decreased serum phosphate&#44; besides albuterol&#44; other bronchodilator agents such as theophylline&#44; atropin&#44; corticosteroids&#44; and i&#46;v&#46; fluids were administered&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In another study&#44; it is reported that hypophosphatemia induced by albuterol is due to the parenteral albuterol administration&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In Massara et al&#39;s study&#44; i&#46;v&#46; infusion of salbutamol caused hypophosphatemia&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In the current study&#44; we used only nebulized salbutamol&#46; Other drugs that may affect serum phosphate levels such as theophylline&#44; corticosteroids and IV fluids were not used&#46; Therefore&#44; this preliminary report indicates that a further study aimed at elucidating the clinical effect of nebulized salbutamol on serum phosphate is required&#46;</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&#46;</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&#46;</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&#46; The corresponding author is in possession of this document&#46;</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&#46;</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 m&#233;todos"
            3 => "Resultados"
            4 => "Conclus&#227;o"
          ]
        ]
        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&#46; A &#946;-adrenergic agonist&#44; salbutamol&#44; was used for this purpose&#46;</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&#59; age over 16 years&#44; asthma history&#44; and an acute exacerbation were included&#46; Serum blood urea nitrogen&#44; creatinine&#44; glucose were within normal limits in all the patients&#46; None of the patients were on chronic theophylline therapy&#46; Baseline serum phosphate and potassium levels were measured&#46; Nebulized salbutamol &#40;2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#41; was used three times at every hour&#46; After 60<span class="elsevierStyleHsp" style=""></span>min&#44; serum phosphate and potassium levels were measured&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Serum phosphate levels decreased from 3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;baseline&#41; to 3&#46;6&#177;0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL at 60<span class="elsevierStyleHsp" style=""></span>min&#46; This decrease was not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;373&#41;&#46; Serum potassium levels decreased significantly &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; from 4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L &#40;baseline&#41; to 4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L &#40;60<span class="elsevierStyleHsp" style=""></span>min&#41;&#46;</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&#46; There was significant hypokalemia&#46; This study indicates that a further study is needed to elucidate the clinical significance of nebulized salbutamol on serum phosphate&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lev&#225;mos a cabo este estudo prospetivo para ampliar a informa&#231;&#227;o dispon&#237;vel relativamente aos n&#237;veis de fosfato s&#233;rico no tratamento de asma aguda&#46; Foi utilizado um agonista &#946;-adren&#233;rgico&#44; salbutamol&#44; para este efeito&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Materiais e m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 26 doentes que cumpriam os crit&#233;rios de inclus&#227;o de&#58; idade superior a 16 anos&#44; hist&#243;ria de asma&#44; incluindo uma exacerba&#231;&#227;o aguda&#46; A ureia do soro sangu&#237;neo&#44; creatinina e glucose estavam nos limites normais em todos os doentes&#46; Nenhum dos doentes era submetido a terapia cr&#243;nica de teofilina&#46; Os n&#237;veis da base de refer&#234;ncia de fosfato e pot&#225;ssio s&#233;rico foram medidos&#46; O nebulizador de salbutamol &#40;2&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#41; era usado 3 vezes por hora&#46; Ap&#243;s 60 min&#44; os n&#237;veis da base de refer&#234;ncia de fosfato e pot&#225;ssio s&#233;rico eram medidos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os n&#237;veis de fosfato s&#233;rico diminu&#237;ram de 3&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;base de refer&#234;ncia&#41; para 3&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL aos 60 min&#46; Esta redu&#231;&#227;o n&#227;o era estatisticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;373&#41;&#46; Os n&#237;veis de pot&#225;ssio s&#233;rico diminu&#237;ram significativamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; de 4&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L &#40;base de refer&#234;ncia&#41; para 4&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L aos 60 min&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A administra&#231;&#227;o de salbutamol nebulizado durante o tratamento de urg&#234;ncia de uma exacerba&#231;&#227;o aguda de asma n&#227;o est&#225; associada a uma diminui&#231;&#227;o estat&#237;stica do fosfato s&#233;rico&#46; Ocorreu uma hipocalemia significativa&#46; Este estudo indica que &#233; necess&#225;rio um estudo adicional para esclarecer o significado cl&#237;nico do salbutamol nebulizado no fosfato s&#233;rico&#46;</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 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;373&#41;&#46; Serum potassium levels decreased significantly &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</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&#46;A&#46; Malfino"
                            1 => "L&#46;J&#46; Nannini"
                            2 => "A&#46;N&#46; Martelli"
                            3 => "A&#46;S&#46; 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&#46;N&#46; Nelson"
                            1 => "A&#46; Hofstadter"
                            2 => "J&#46; Parker"
                            3 => "C&#46; 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&#46;C&#46; Webb-Johnson"
                            1 => "J&#46;L&#46; Andrews"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM197709012970905"
                      "Revista" => array:6 [
                        "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            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&#46;M&#46; Gelmont"
                            1 => "J&#46;R&#46; Balmes"
                            2 => "A&#46; 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 &#946;-2 adrenoceptor agonists salbutamol and rimiterol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;J&#46; Phillips"
                            1 => "A&#46;E&#46; Vedig"
                            2 => "P&#46;L&#46; Jones"
                            3 => "M&#46;G&#46; Chapman"
                            4 => "M&#46; Collins"
                            5 => "J&#46;B&#46; 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 &#946;-2 receptor stimulation by circulating epinephrine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Brown"
                            1 => "D&#46;C&#46; Brown"
                            2 => "M&#46;B&#46; 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&#46; DaCruz"
                            1 => "C&#46; 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&#46;R&#46; Brady"
                            1 => "F&#46; Ryan"
                            2 => "J&#46; Cunningham"
                            3 => "W&#46; Tormey"
                            4 => "M&#46;P&#46; Ryan"
                            5 => "S&#46; O&#8217;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&#58; comparison of aerosol and intravenous administration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Neville"
                            1 => "J&#46;B&#46; Palmer"
                            2 => "J&#46; Gaddie"
                            3 => "C&#46;S&#46; May"
                            4 => "K&#46;N&#46; Palmer"
                            5 => "L&#46;E&#46; 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&#46; Masara"
                            1 => "V&#46; Fassio"
                            2 => "F&#46; Camanni"
                            3 => "V&#46; Martina"
                            4 => "G&#46; 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 &#946;-agonists for asthma&#58; effects on serum electrolytes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Bodenhamer"
                            1 => "R&#46; Bergstrom"
                            2 => "D&#46; Brown"
                            3 => "P&#46; Gabow"
                            4 => "J&#46;A&#46; Marx"
                            5 => "S&#46;R&#46; Lowenstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Global Strategy for Asthma Management and Prevention 2011 &#40;update&#41; &#40;<a id="intr0005" class="elsevierStyleInterRef" href="http://www.ginasthma.org/">www&#46;ginasthma&#46;org</a>&#41;&#44; p&#46; 72&#46;"
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Albuterol&#58; an adrenergic agent for use in the treatment of asthma phamacology&#44; pharmacokinetics and clinical use"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;C&#46; Ahrens"
                            1 => "G&#46;D&#46; 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" => "/21735115/0000001900000005/v3_201405231121/S2173511513000742/v3_201405231121/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9710"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001900000005/v3_201405231121/S2173511513000742/v3_201405231121/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000742?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 19. Issue 5.
Pages 200-203 (September - October 2013)
Share
Share
Download PDF
More article options
Visits
1113
Vol. 19. Issue 5.
Pages 200-203 (September - October 2013)
Original article
Full text access
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
Visits
1113
M. Sahana, M. Yılmazb, Y. Gokelc, E.S. Erdend, A. Karakuse,
Corresponding author
drkarakus@yahoo.com

Corresponding author.
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
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Abstract
Objective

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.

Material and methods

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 (2.5mg) was used three times at every hour. After 60min, serum phosphate and potassium levels were measured.

Results

Serum phosphate levels decreased from 3.7±0.9mg/dL (baseline) to 3.6±0.9mg/dL at 60min. This decrease was not statistically significant (p=0.373). Serum potassium levels decreased significantly (p<0.001) from 4.6±0.7mmol/L (baseline) to 4.3±0.7mmol/L (60min).

Conclusion

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.

Keywords:
Salbutamol
Phosphate
Asthma
Resumo
Objetivo

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.

Materiais e métodos

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 (2,5mg) era usado 3 vezes por hora. Após 60 min, os níveis da base de referência de fosfato e potássio sérico eram medidos.

Resultados

Os níveis de fosfato sérico diminuíram de 3,7±0,9mg/dL (base de referência) para 3,6±0,9mg/dL aos 60 min. Esta redução não era estatisticamente significativa (p=0,373). Os níveis de potássio sérico diminuíram significativamente (p<0,001) de 4,6±0,7mmol/L (base de referência) para 4,3±0,7mmol/L aos 60 min.

Conclusão

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.

Palavras-chave:
Salbutamol
Fosfato
Asma
Full Text
Introduction

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.1 Nebulized β-adrenergic agonists are the mainstay of treatment for acute exacerbation of asthma in the emergency setting.2 β-Adrenergic agonists (BAA) have side effects such as tremor, palpitations, tachycardia, and anxiety.3 There are several studies that demonstrate a statistically significant decrease in serum potassium and magnesium after BAA administration.4–7 In addition, there are also some studies regarding the BAA induced hypophosphatemia.8–11 In the current research, our aim is to investigate Serum Potassium and Phosphate Levels at the 60min after administration of Nebulized Salbutamol for Asthma.

Materials and methods

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 2011.12

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 (2.5mg).

Nebulized salbutamol (2.5mg) was used three times during the first hour. After the third administration of salbutamol, serum phosphate and potassium levels were assessed.

None of the patient received magnesium, potassium, phosphate, corticosteroids, theophylline, and i.v. dextrose or saline during the study period.

The mean and standard deviation were calculated for baseline and subsequent measure of phosphate and potassium. Paired-t test was used for analyzing the changes in case of phosphate and potassium levels. p-Value <0.05 was considered statistically significant.

Results

Twenty-six patients were enrolled during the study period. The mean patient age was 58.8±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 (2.5mg, every 20min). 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.

There was an average duration of symptoms of 30±35h (range 2–55) before seeking medical attention. Mean baseline peak expiratory flow rate averaged 210±110L/min (range 100–320L/min).

Although serum phosphate levels decreased from a mean of 3.7±0.9mg/dL at baseline to 3.6±0.9mg/dL at 60min, no significant decrease was found (Fig. 1).

Figure 1.

Serum phosphate levels did not decrease significantly during the treatment (p=0.373). Serum potassium levels decreased significantly (p<0.001).

(0.09MB).

Serum potassium levels decreased significantly from 4.6±0.7 (baseline) to 4.3±0.7mmol/L (60min) (p<.001) (Fig. 1).

Discussion

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.

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.4–7 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.

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±0.9mg/dL at baseline to 3.6±0.9mg/dL at 60min. No significant correlation was found. This result is not consistent with previous studies.

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.

Secondly, our patients were not receiving theophylline, diuretics, antihypertensive, and antidiabetics before they arrived at the emergency department.

In one study BAA induced hypophosphatemia, but BAA and other bronchodilator drugs were used together.8

In a different study, BAA decreased serum phosphate, besides albuterol, other bronchodilator agents such as theophylline, atropin, corticosteroids, and i.v. fluids were administered.11

In another study, it is reported that hypophosphatemia induced by albuterol is due to the parenteral albuterol administration.13

In Massara et al's study, i.v. infusion of salbutamol caused hypophosphatemia.10

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.

Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

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.

Right to privacy and informed consent

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.

Conflicts of interest

The authors have no conflicts of interest to declare.

References
[1]
N.A. Malfino, L.J. Nannini, A.N. Martelli, A.S. Slutsky.
Respiratory arrest in near fatal asthma.
N Engl J Med, 324 (1991), pp. 285-288
[2]
M.N. Nelson, A. Hofstadter, J. Parker, C. Hargis.
Frequency of inhaled metaproterenol in the treatment of acute asthma exacerbation.
Ann Emerg Med, 19 (1990), pp. 21-25
[3]
D.C. Webb-Johnson, J.L. Andrews.
Bronchodilator therapy.
N Engl J Med, 297 (1977), pp. 476-482
[4]
D.M. Gelmont, J.R. Balmes, A. Yee.
Hypokalemia induced by bronchodilators.
Chest, 94 (1988), pp. 763-766
[5]
P.J. Phillips, A.E. Vedig, P.L. Jones, M.G. Chapman, M. Collins, J.B. Edwards, et al.
Metabolic and cardiovascular side effects of the β-2 adrenoceptor agonists salbutamol and rimiterol.
Br J Clin Pharmacol, 9 (1980), pp. 483-491
[6]
M.J. Brown, D.C. Brown, M.B. Murphy.
Hypokalemia from β-2 receptor stimulation by circulating epinephrine.
N Engl J Med, 309 (1983), pp. 1414-1419
[7]
D. DaCruz, C. Holburn.
Serum potassium responses to nebulized salbutamol administered during an acute asthmatic attack.
Arch Emerg Med, 6 (1989), pp. 22-26
[8]
H.R. Brady, F. Ryan, J. Cunningham, W. Tormey, M.P. Ryan, S. O’Neill.
Hypophosphatemia complicating bronchodilator therapy for acute severe asthma.
Arch Intern Med, 149 (1989), pp. 2367-2368
[9]
A. Neville, J.B. Palmer, J. Gaddie, C.S. May, K.N. Palmer, L.E. Murchison.
Metabolic effects of salbutamol: comparison of aerosol and intravenous administration.
Br Med J, 1 (1977), pp. 413-414
[10]
F. Masara, V. Fassio, F. Camanni, V. Martina, G. Molinatti.
Some metabolic and hormonal effects of salbutamol in man.
Acta Diabetol Lat, 13 (1976), pp. 146-153
[11]
J. Bodenhamer, R. Bergstrom, D. Brown, P. Gabow, J.A. Marx, S.R. Lowenstein.
Frequently nebulized β-agonists for asthma: effects on serum electrolytes.
Ann Emerg Med, 21 (1992), pp. 53-58
[12]
Global Strategy for Asthma Management and Prevention 2011 (update) (www.ginasthma.org), p. 72.
[13]
R.C. Ahrens, G.D. Smith.
Albuterol: an adrenergic agent for use in the treatment of asthma phamacology, pharmacokinetics and clinical use.
Pharmacotherapy, 4 (1984), pp. 105-121
Copyright © 2012. Sociedade Portuguesa de Pneumologia
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?