Abstract: FR-OR108
Acute Treatment of Hyperkalemia in the Emergency Department: A Randomized Clinical Trial
Session Information
- Late-Breaking Research Orals: AKI, CKD, CKM, and More
October 23, 2026 | Location: Four Seasons Ballroom 2, Convention Center
Abstract Time: 04:30 PM - 04:42 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Montassier, Emmanuel, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- Rossignol, Patrick, Centre Hospitalier Princesse Grace, Monaco-Ville, Monaco
- Legrand, Matthieu, University of California San Francisco, San Francisco, California, United States
Background
Nebulized β2-agonists and intravenous insulin–dextrose are commonly used to lower serum potassium in acute hyperkalemia, but their comparative effectiveness in the emergency department is uncertain. The primary objective of this study was to compare intravenous insulin–dextrose infusion, nebulized salbutamol, and their combination for reducing serum potassium concentration in adults presenting to the ED with hyperkalemia.
Methods
This is a multicenter, open-label, superiority randomized clinical trial conducted in 13 French emergency departments from December 20, 2019, through December 31, 2025. Adults (≥18 years) with a serum potassium concentration of 5.5 mmol/L or greater were enrolled; the eligibility threshold was lowered from 6.0 to 5.5 mmol/L by protocol amendment during the trial. Participants were randomly assigned 1:1:1 to nebulized salbutamol (10 mg over 30 minutes), intravenous insulin (10 units) with 500 mL of 10% dextrose over 30 minutes, or both at the same dosages. The primary outcome was the mean change in serum potassium concentration from baseline to 60 minutes. Secondary outcomes included change at 180 minutes and 24 hours, normokalemia, retreatment or dialysis, and adverse events.
Results
Of 410 patients randomized, 398 were analyzed (133 salbutamol, 133 insulin–dextrose, 132 combination); median age was 76 years and 131 (33%) were women. The median baseline serum potassium was 6.2 mmol/L. The mean 60-minute decrease in serum potassium was 0.8 mmol/L (salbutamol), 1.1 mmol/L (insulin–dextrose), and 1.3 mmol/L (combination). Combination therapy produced a greater reduction than salbutamol alone (adjusted difference, 0.44 mmol/L; 95% CI, 0.28-0.59; P<.001) and insulin–dextrose alone (adjusted difference, 0.22 mmol/L; 95% CI, 0.06-0.39; P=.008). Adverse events did not differ materially, except for less frequent hyperglycemia with salbutamol.
Conclusion
Among adults with acute hyperkalemia in the emergency department, insulin–dextrose plus nebulized salbutamol produced a modestly greater reduction in serum potassium at 60 minutes than either treatment alone. Whether this biochemical difference improves clinical outcomes remains uncertain.
Funding
- Government Support - Non-U.S.