Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

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Dr Saumya Navit
Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3460 - 3464

A Study Of Serum Electrolyte Levels During Nebulised Salbutamol Therapy

VITTAL B G*, RUDRESHA B M*, ALIYA N*, PRIYADARSHINI K S*

*MD Biochemistry, Department of Biochemistry, Adichunchanagiri Institute of Medical Sciences, BG Nagar, Mandya District, Karnataka

Correspondence Address :
Dr. Vittal BG,
Assistant Professor,
Department of Biochemistry,
Government Medical College,
Hassan-573 201,
Karnataka
Mobile No: 09141400766
Email: vittal.bg@gmail.com

Abstract

Background and objectives: Asthma is a very common disease with immense social impact. Nebulised salbutamol is the mainstay of therapy in acute severe asthma. This prospective study was done to determine the magnitude of changes in serum magnesium, potassium, phosphate and calcium during the treatment of acute severe asthma with nebulised salbutamol alone in a larger sample size, as previous studies were carried on a smaller sample size and yielded ambiguous results.
Subjects and Methods: Sixty patients who met the inclusion criteria were included and their baseline electrolyte levels were measured. Nebulised salbutamol was administered every thirty minutes till the symptoms subsided and repeat serum levels of electrolytes were determined after 90 minutes.
Results: Serum magnesium levels decreased significantly (p < 0.001) from 2.058 ± 0.0263 mg/dl to 2.048 ± 0.0268 mg/dl. Serum potassium levels decreased from 4.053 ± 0.0485 mEq/L to 3.983 ± 0.0482 mEq/L (p < 0.001). Serum phosphate levels decreased significantly (p < 0.001) from 3.899 ± 0.0299 mg/dl to 3.872 ± 0.0296 mg/dl, but no statistical difference was seen in the Serum calcium levels. Interpretation and Conclusion: Nebulised salbutamol therapy is associated with statistically significant decreases in serum magnesium, potassium and phosphate levels.

Keywords

Asthma, electrolyte levels, salbutamol therapy.

How to cite this article :

VITTAL B G, RUDRESHA B M, ALIYA N, PRIYADARSHINI K S. A STUDY OF SERUM ELECTROLYTE LEVELS DURING NEBULISED SALBUTAMOL THERAPY. Journal of Clinical and Diagnostic Research [serial online] 2010 December [cited: 2019 Aug 26 ]; 4:3460-3464. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2010&month=December&volume=4&issue=6&page=3460-3464&id=996

INTRODUCTION
Bronchial asthma is one of the most common diseases globally and it currently affects ~ 300 million people. Asthma is a very common disease with immense social impact, with a prevalence of ~10-12% in adults and 15% in children. It is known to occur at all ages, with a slight male preponderance (1).

Asthma is defined as a chronic inflammatory disease of the airways, that is characterised by increased responsiveness of the tracheobronchial tree, leading to the narrowing of the air passages, which may be relieved spontaneously or as a result of therapy and clinically by paroxysms of dyspnoea, cough and wheezing. It is an episodic disease with acute exacerbations which are interspersed with symptom free periods. Typically, most attacks are short lived, lasting minutes to hours and clinically, the patient seems to recover completely after an attack. However, there can be a phase in which the patient experiences some degree of airway obstruction daily. This phase can be mild or serious, with severe obstruction persisting for days or weeks; the latter condition is known as acute severe asthma. Acute episodes of asthma are one of the most common respiratory emergencies (2).

Drug therapy is the most commonly used mode of treatment for asthma. The drugs which are used to treat asthma are β–adrenergic agonists, methyl xanthines, glucocorticoids and mast cell stabilizing agents.

β – Adrenergic agonists have been the primary focus of the emergency management of acute severe asthma for over 50 years (3). Multiple inhalations of short acting sympathomimetic drugs such as salbutamol, are the cornerstone of most regimens (2). The administration of nebulised salbutamol during the emergency treatment of acute severe asthma was shown to be associated with a significant decrease in serum magnesium, potassium and phosphate levels (4),(5).
Literature search revealed few groups that have studied the changes in electrolyte levels during nebulised salbutamol therapy. Previous studies were conducted on a very small sample size and yielded ambiguous results.
This study intended to measure and evaluate the changes in serum magnesium and other electrolyte levels on the administration of nebulised salbutamol in 60 patients of acute severe asthma.

Material and Methods

This study included 60 clinically diagnosed cases of acute severe asthma who got admitted to the emergency department of a teaching hospital, who fulfilled the inclusion criteria and who gave consent to participate in the study. The study spanned over a period of 15 months from August 2008 to October 2009.

Clinically diagnosed patients of acute severe asthma who were treated with nebulised salbutamol were included in the study. All patients with chronic liver diseases, chronic renal failure and acute myocardial infarction were excluded. Patients who were aged less than 16 years, those with metabolic disorders, pregnant women and psychiatric patients were also excluded from this study group.

Blood samples were drawn under aseptic precautions from clinically diagnosed cases of acute severe asthma before and after the administration of nebulised salbutamol. Both the blood samples were analysed for the study parameters.

After getting the written consent, 3ml of venous blood sample was drawn in a disposable syringe before the start of nebulised salbutamol therapy. Precaution was taken to prevent sepsis and haemolysis. The sample was then transferred to a mineral free acid washed glass test tube and was allowed to stand for 20-30 minutes, after which it was centrifuged to separate serum. Nebulised salbutamol (2.5mg) was administered every 30 minutes until the patient was discharged from the emergency department. Each dose was administered over a period of 10 minutes. Apart from inhaled oxygen supplementation, no other drug was administered during the course of the treatment. A repeat blood sample was drawn 90 minutes after starting nebulised salbutamol therapy, as the peak serum concentration of salbutamol is reached at 90 minutes (6). The repeat samples were processed similarly to separate serum.

The serum levels of magnesium, calcium, potassium and phosphate were measured in both the sets of the serum samples.

Serum magnesium levels were assayed by Mann and Yoe’s Xylidyl blue method, which is an in vitro colourimetric method for the quantitative determination of magnesium in serum (7). Serum Calcium levels were measured by the modified O- Cresolpthalein Complexone method (8). Serum phosphorus levels were estimated by the ammonium molybdate method, based on the modified Daly and Ertingshausen’s method (9). Serum potassium was measured by an electrolyte analyser that measures ionic potassium by a K+ ion selective electrode.

The levels of the four electrolytes (Magnesium, Calcium, Phosphate, and Potassium) were estimated twice, before and after the administration of nebulised salbutamol to the same study group. The study group consisted of 60 clinically diagnosed cases of acute severe asthma. The results were tabulated and analysed by using the “Paired ‘t’ test” for any statistically significant changes in the electrolyte levels before and after the treatment.

Results

Among the 60 subjects who were a part of the study, 36 (60%) were men and 24 (40%) were women. 24 of the 60 patients were aged less than 30 years, while 30 patients were between the age group of 31 to 50 years and 6 were aged more than 50 years. (Table/Fig 1)

(Table/Fig 1): Age – Sex Distribution of Study Group


The changes in serum magnesium, potassium, phosphate, and calcium levels before and 90 minutes after nebulised salbutamol therapy were measured and tabulated. (Table/Fig 2)

(Table/Fig 2): Changes in Serum Electrolyte Levels

Serum concentrations are depicted as Mean± Standard Error

The baseline magnesium level before the administration of salbutamol in patients of acute severe asthma was 2.058 ± 0.026 mg/dl (Mean ± Standard error) and it decreased significantly (p < 0.001) 90 minutes after the administration of salbutamol, to 2.048 ± 0.027 mg/dl.

The serum potassium level which was measured before the administration of salbutamol was 4.053 ± 0.048 mmol/L, which decreased after treatment with salbutamol to 3.983 ± 0.048 mmol/L. This decrease was found to be statistically significant (p < 0.001) on applying the paired t test to find the level of significance.

The baseline serum phosphate level which was measured at admission was 3.899 ± 0.030 mg/dl, which decreased to 3.872 ± 0.029 mg/dl after the administration of β–adrenergic agonists. This decrease was statistically significant (p < 0.001).

The serum calcium level which was measured before the administration of the β–adrenergic agonist, salbutamol (base line calcium levels) was 9.532 ± 0.051 mg/dl and it decreased after the administration of salbutamol to 9.532 ± 0.050 mg/dl. This decrease was statistically not significant (p > 0.10).

Discussion

The patients of acute severe asthma were treated with nebulised salbutamol alone and serum electrolytes were measured before and after 90 minutes of therapy to determine the magnitude of change in the serum concentrations.

Serum magnesium, potassium, and phosphate levels decreased significantly after the initiation of nebulised salbutamol therapy, as compared to the baseline levels or the electrolyte levels before the initiation of nebulised salbutamol therapy. Serum calcium levels did not show any significant changes during the course of the study.

The cause of hypomagnesaemia due to the β2–adrenergic agonists is still unclear, which can probably be explained by the epinephrine like action of the β2–adrenergic agonists on magnesium uptake by the adipocytes. Hypomagnesaemia is associated with tremor, low potassium and ventricular ectopic activity. Interestingly, these adverse effects are seen in therapeutic or excessive doses of salbutamol. Therefore, hypomagnesaemia can be considered as a common denominator to help explain these effects of β2–adrenergic agonists (10).

Hypomagnesaemia may increase the neuromuscular irritability, thus making a few individuals more susceptible to the bronchial spasms. It is noteworthy that hypomagnesaemia which causes bronchoconstriction is a side effect of salbutamol, which is a potent bronchodilator. However, this bronchoconstriction might be of a very small magnitude.

A statistically significant decrease (p<0.001) in serum magnesium levels was observed in our study after the treatment with nebulised salbutamol, when compared with the baseline levels. A serial and statistically significant decrease (p<0.001) was also observed by Bodenhamer in his study, with an aggressive administration of nebulised salbutamol (4). Khilnani also reported a decrease in serum magnesium levels with the use of the β2–adrenergic agonists (10). However, a few studies have reported that no statistically significant change of serum magnesium levels was observed in patients who were treated with nebulised salbutamol (11).

In our study, serum potassium levels were found to decrease significantly after the treatment with nebulised salbutamol (p<0.001). A statistically significant decrease in serum potassium levels was also observed after salbutamol therapy in other studies (4), (10), (12), (13) and also in a study on patients of the paediatric age group (14). Nevertheless, a study pointed out that only intravenous salbutamol led to a decrease in serum potassium levels, while nebulised salbutamol did not result in significant changes (15).

Hypokalaemia is known to occur in therapeutic and excessive doses of β2– agonists. This effect is attributed to the activation of the Na+-K+-ATPase enzyme and β2 receptor mediated insulin release, with a consequent intracellular shift of potassium (12).

The serum phosphate levels were found to decrease significantly in our study (p<0.001) after treatment with nebulised salbutamol and a similar observation was made by Bodenhamer in his study (4).

Serum calcium levels did not show any statistically significant changes during the salbutamol therapy in our study.

The limitation of this study was that randomisation and placebo control were not done, as they were not practically feasible in our setup. If the study had taken into account, the history of the asthma medications that the patients took before therapy, the results could have been attributed more directly to salbutamol therapy.

Our study results indicated that serum electrolytes like magnesium potassium and phosphate decreased significantly in patients with acute severe asthma who were on treatment with nebulised salbutamol. The decrease in electrolyte levels was only statistically significant and the levels did not decrease below the decision limits. The mechanism and clinical significance of these findings are unclear and they warrant further studies.

It is recommended that further studies must be carried out on a larger sample size and also, the clinical findings should be correlated with the dose dependent variation in electrolyte levels during salbutamol therapy.

References

1.
Waltraud Eder, Markus J Ege, Erika von Mutius. The Asthma Epidemic. N Engl J Med 2006;355:2226-35.
2.
Casper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson L. Harrison’s Principles of Internal medicine. 17th ed. McGraw-Hill Medical publications; 2008: 1596-1599p.
3.
Skobeloff EM, Spivey WH, McNamara RM, Greenspon L. Intravenous Magnesium Sulphate for the Treatment of Acute Severe Asthma in the Emergency Department. JAMA 1989; 262: 1210-1213.
4.
Bodenhamer J., Bergstrom R, Brown D, Gabow P, Marx JA, Lowenstein SR. Frequently nebulised beta agonists for Asthma- Effects on serum electrolytes. Ann Emerg Med Nov 1992; 21(11): 1337-1342.
5.
Dickens GR. et al. Effect of nebulised albuterol on serum potassium and cardiac rhythm in patients with asthma or chronic obstructive pulmonary disease. Pharmacotherapy 1994; 14(6): 729-733.
6.
Mohamed MH, Lima JJ, Eberle LV, Self TH, Johnson JA. Effects of gender and race on albuterol pharmacokinetics. Pharmacotherapy 1999; 19: 157-161.
7.
Mann CK, Yoe JH, Spectrophotometric determination of magnesium with xylidyl blue. Anal Chem Acta 1957; 16: 155-160.
8.
Moorehead WR, Briggs HG. 2-Amino 2-methyl 1-propanol as the alkalysing agent in the improved continuous flow cresolpthalein complexone procedure for calcium in serum. Clin Chem 1974; 20: 1458-1460.
9.
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