Frequency of hypokalemia in patients with salbutamol nebulization

ABSTRACT Objective:To determine the frequency of hypokalemia and evaluate changes in serum potassium levels following nebulized Salbutamol therapy in children presenting with mild asthma exacerbation. Methodology:This cross-sectional study was conducted in the Pediatric Emergency Department of Civil Hospital Karachi over six months. A total of 370 children aged 1–12 years presenting with mild asthma exacerbation and requiring nebulized Salbutamol were included through consecutive sampling. Children with chronic illnesses, potassium-altering medications, or systemic disorders were excluded. Nebulized Salbutamol was administered in three standardized doses (2.5 mg for <20 kg and 5 mg for ≥20 kg). Serum potassium levels were measured before and 30 minutes after therapy. Hypokalemia was defined as serum potassium <3.5 mmol/L. Data were analyzed using appropriate statistical tests, and logistic regression was applied to identify predictors. Results:The mean age was 7.1 ± 2.6 years, and 60.5% were males. The mean baseline serum potassium was 4.18 ± 0.46 mmol/L, which significantly decreased to 3.76 ± 0.49 mmol/L after nebulization (p < 0.001), showing a mean decline of 0.42 mmol/L. Hypokalemia developed in 27.8% (n = 103) of children. Higher frequency was observed among children <5 years (p = 0.01), those receiving 5 mg Salbutamol (p = 0.003), and malnourished children (p < 0.001). Logistic regression confirmed younger age, higher dose, and malnutrition as independent predictors. Conclusion:Nebulized Salbutamol significantly reduces serum potassium levels and may induce hypokalemia even in mild asthma. Younger children, malnourished patients, and those receiving higher doses are at increased risk; therefore, careful dosing and consideration of potassium monitoring in high-risk groups are recommended. Keywords: Salbutamol, Hypokalemia, Asthma, Children, Nebulization, Serum Potassium, Pakistan