Inhaled albuterol offers more accessible treatment option for elevated potassium levels in cats

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A new study, published in the Journal of the American Veterinary Medical Association (JAVMA), found that inhaled albuterol rapidly decreased blood potassium concentrations in cats. Study results offer a potential treatment option for cats with hyperkalemia undergoing surgery or other medical procedures.¹

In felines, a urinary tract obstruction is the most common cause of hyperkalemia. A ruptured urinary bladder can also lead to high potassium levels in these animals.² Moreover, patients of any species with moderate to severe hyperkalemia can exhibit generalized muscle weakness, depression, and cardiac conduction disturbances that can result in life-threatening cardiac arrhythmias.^2,3

“Urinary tract disease is relatively common in cats, and decreased renal excretion of potassium in these conditions is the most common cause of hyperkalemia in cats,” the study's authors wrote.³

In humans, inhaled albuterol is supported as a first-line therapy for acutely managing hyperkalemia, with the treatment lowering potassium concentrations within 15 to 30 minutes of administration. Effects of inhaled albuterol in humans can last up to 180 minutes.³

“Albuterol is a β₂-agonist that stimulates an intracellular redistribution of potassium through induction of endogenous insulin secretion and activation of membrane-bound Na/K-ATPase pumps in skeletal muscle and liver cells independent of insulin,” the study's authors wrote.³

For the study, 20 healthy, spayed/neutered cats received albuterol sulfate at doses of either 90 µg or 360 µg through a mask that was placed over their muzzles. Fifteen were domestic shorthair, 3 were domestic longhair, 1 was a domestic medium hair, and 1 was a Sphynx. Ages of the cats ranged from 1.1 years to 7 years and the median weight was 5 kg.

Blood samples and heart rate from the participants were taken at baseline and at 10 time points following administration of albuterol sulfate, with the final sample taken 360 minutes after the tenth inhalation. Blood potassium and glucose concentrations were measured using a blood gas analyzer, while plasma insulin levels were assessed through radioimmunoassay.³

Cats enrolled in the study did not have a prior or newly documented history of cardiac abnormality. Felines who had been administered any medications that may alter blood potassium—such as insulin, sodium-glucose cotransporter-2 inhibitors, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, potassium gluconate, and potassium citrate—were also not eligible for enrollment.

The results showed that inhaled albuterol rapidly decreased blood potassium levels in under 3 minutes, with peak effects happening at 30 minutes after administration and lasting for at least 180 minutes.^1,3 The average maximum decrease in blood potassium concentration occurred in the cats who received the lower dose (90 µg) of albuterol, with the decrease being 0.52 mmol/L.³

Additionally, plasma insulin levels increased rapidly after the administration of inhaled albuterol, peaking at 30 minutes and decreasing below baseline by 360 minutes. Time significantly impacted these levels but albuterol dose and the interaction of albuterol dose and time did not impact plasma insulin levels. Both low- and high-dose albuterol cohorts saw significant increases in plasma insulin compared to baseline, but there were no significant differences between the 2 doses.

Additionally, blood glucose levels rose after inhaling albuterol, peaking at 60 minutes for the low-dose group and at 120 minutes for the high-dose group, with both returning to levels below baseline by 360 minutes.

Conducted by researchers at Midwestern University College of Veterinary Medicine in Glendale, Arizona, and Michigan State University in East Lansing, the study’s findings suggest a more affordable and easily accessible treatment option for lowering potassium levels before surgery or other procedures, offering an alternative to other existing methods, according to the AVMA.¹

References

1. Study identifies possible treatment for cats with elevated potassium levels due to urinary obstructions. News release. American Veterinary Medical Association. March 27, 2025. Accessed April 2, 2025. https://www.avma.org/news/study-identifies-possible-treatment-cats-elevated-potassium-levels-due-urinary-obstructions?utm_source=delivra&utm_medium=email&utm_campaign=todays-headlines-news
2. Constable PD. Disorders of potassium metabolism in cats. Merck Veterinary Manual. September 2024. Accessed April 2, 2025. https://www.merckvetmanual.com/cat-owners/metabolic-disorders-of-cats/disorders-of-potassium-metabolism-in-cats
3. Jaffey JA, Cunha A da, Kushiro-Banker T, et al. Inhaled albuterol rapidly decreases whole blood potassium and increases plasma insulin concentrations, with peak effects 30 minutes after administration in cats. Journal of the American Veterinary Medical Association. Published online March 26, 2025:1-8. doi:10.2460/javma.25.01.0054