Case Report: Inhaled salbutamol in the successful treatment of life-threatening acute hyperkalaemia in an anaesthetised horse.
Authors: Rollet Madelyn, Flyps Jana, Vernemmen Ingrid, van Loon Gunther, Schauvliege Stijn
Journal: Frontiers in veterinary science
Summary
# Editorial Summary Acute hyperkalaemia during equine general anaesthesia is rare but potentially fatal, presenting particular challenges when standard treatments prove insufficient. This case report documents a 13-year-old Trotter undergoing cardiac mapping who developed severe intra-operative hyperkalaemia (rising from 7.55 to 8.00 mmol/L; normal 3.00–4.00 mmol/L) with atrial standstill on ECG, requiring emergency transvenous pacing and initial management with insulin and dextrose. When conventional therapy failed to reverse the rising potassium, the addition of inhaled salbutamol (5 µg/kg) alongside intravenous furosemide (0.93 mg/kg) prompted rapid clinical improvement, with spontaneous atrial contraction returning within eight minutes and potassium concentrations declining on subsequent blood samples. Whilst this represents the first documented use of inhaled salbutamol for acute perioperative hyperkalaemia in horses, the mechanism—beta-2 agonist-induced intracellular potassium shift—is well-established in human emergency medicine, suggesting anaesthetists should consider this accessible intervention when standard agents fail to control dangerous serum potassium elevations. The case underscores both the importance of vigilant intra-operative monitoring and the potential benefit of having alternative hyperkalaemia treatments immediately available in the operating theatre.
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Practical Takeaways
- •Inhaled salbutamol is an effective emergency treatment option for life-threatening hyperkalaemia during equine general anaesthesia and should be considered in your emergency drug protocols
- •When hyperkalaemia is detected during surgery, combination therapy (insulin/glucose, beta-2 agonist, and diuretic) may be more effective than single-agent treatment
- •Continuous ECG and serial blood potassium monitoring during prolonged anaesthesia can detect dangerous electrolyte shifts early enough for intervention
Key Findings
- •Life-threatening hyperkalaemia (8.00 mmol/L) developed intra-operatively during cardiac electrophysiology mapping in an anaesthetised horse
- •Inhaled salbutamol (5 µg/kg) combined with intravenous furosemide produced rapid potassium reduction within 8 minutes
- •Return of spontaneous atrial contraction occurred on echocardiography following salbutamol administration after initial atrial standstill
- •This is the first documented case of inhaled salbutamol successfully treating acute hyperkalaemia in an anaesthetised equine patient