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Home / Equine Research Bank / Front Vet Sci / Case Report: Inhaled salbutamol in the successful treatment ...
Frontiers in veterinary science2026; 12; 1663681; doi: 10.3389/fvets.2025.1663681

Case Report: Inhaled salbutamol in the successful treatment of life-threatening acute hyperkalaemia in an anaesthetised horse.

Abstract: Hyperkalaemia is an uncommon complication of general anaesthesia in healthy horses. This case report describes the occurrence of life-threatening acute hyperkalaemia in a 13-year-old, female French Trotter anaesthetised for experimental right and left atrial 3D electro-anatomical mapping. Intra-operative development of hyperkalaemia (7.55 mmol/L) (Ref. 3.00-4.00 mmol/L) with atrial standstill on ECG necessitated transvenous ventricular pacing while initial treatment with insulin and glucose was initiated. Plasma potassium levels continued to increase (8.00 mmol/L) prompting adjunctive treatment with 5 μg/kg of inhaled salbutamol and intravenous furosemide 0.93 mg/kg. Eight minutes after salbutamol administration, return of spontaneous atrial contraction was observed on echocardiography and plasma potassium concentration rapidly decreased on serial blood samples. To the authors' knowledge, this is the first case report documenting the use of inhaled salbutamol in the treatment of life-threatening acute hyperkalaemia in an anaesthetised horse.
Copyright © 2026 Rollet, Flyps, Vernemmen, van Loon and Schauvliege.
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Publication Date: 2026-01-16 PubMed ID: 41624282PubMed Central: PMC12856927DOI: 10.3389/fvets.2025.1663681Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This case report details the successful treatment of a life-threatening acute hyperkalaemia episode in an anaesthetised horse using inhaled salbutamol, alongside other interventions.

Background

  • Hyperkalaemia refers to an abnormally high level of potassium in the blood.
  • It is uncommon in healthy horses undergoing general anaesthesia but can be life-threatening if it occurs.
  • High potassium levels can cause severe cardiac disturbances including atrial standstill, which is a cessation of atrial electrical activity and contraction.

Case Description

  • The subject was a 13-year-old female French Trotter horse under general anaesthesia for experimental 3D electro-anatomical mapping of the right and left atria.
  • During surgery, plasma potassium levels rose sharply to 7.55 mmol/L (normal reference range is 3.00-4.00 mmol/L), accompanied by atrial standstill detected on ECG.
  • To manage this, transvenous ventricular pacing was initiated to maintain heart rhythm while initial treatments commenced.

Treatment Administered

  • Initial therapy included insulin and glucose administration, which is standard to promote cellular uptake of potassium and reduce blood potassium levels.
  • Despite this, potassium concentrations further increased to 8.00 mmol/L, indicating refractory hyperkalaemia.
  • Adjunctive treatments were then introduced:
    • Inhaled salbutamol at a dose of 5 μg/kg – a beta-2 adrenergic agonist that drives potassium into cells by stimulating the Na+/K+ ATPase pump.
    • Intravenous furosemide at 0.93 mg/kg – a loop diuretic to promote urinary potassium excretion.

Outcome and Significance

  • Eight minutes after administering inhaled salbutamol, spontaneous atrial contractions resumed, demonstrated by echocardiography.
  • Serial blood tests showed a rapid decline in plasma potassium levels following this treatment.
  • The case demonstrates inhaled salbutamol’s effectiveness as a rapid adjunct therapy for acute hyperkalaemia during anaesthesia in horses.
  • This is reportedly the first documented use of inhaled salbutamol specifically for life-threatening acute hyperkalaemia in an anaesthetised horse.

Clinical Implications

  • The report highlights the importance of monitoring potassium and cardiac function during equine anaesthesia, even in healthy subjects.
  • Inhaled salbutamol can be considered a safe and effective emergency treatment option for hyperkalaemia when conventional therapies are insufficient.
  • Prompt intervention with multiple therapies targeting different mechanisms may be necessary for severe hyperkalaemia cases.
  • This insight can guide clinicians in managing similar cases to prevent fatal cardiac complications.

Cite This Article

APA
Rollet M, Flyps J, Vernemmen I, van Loon G, Schauvliege S. (2026). Case Report: Inhaled salbutamol in the successful treatment of life-threatening acute hyperkalaemia in an anaesthetised horse. Front Vet Sci, 12, 1663681. https://doi.org/10.3389/fvets.2025.1663681

Publication

Frontiers in veterinary science
ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 12
Pages: 1663681
PII: 1663681

Researcher Affiliations

Rollet, Madelyn
  • Department of Anaesthesia, Southern Counties Veterinary Specialists, Hampshire, United Kingdom.
Flyps, Jana
  • Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Ghent, Belgium.
Vernemmen, Ingrid
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Equine Cardioteam Ghent, Ghent, Belgium.
van Loon, Gunther
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Equine Cardioteam Ghent, Ghent, Belgium.
Schauvliege, Stijn
  • Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Ghent, Belgium.

Conflict of Interest Statement

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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