To determine whether epinephrine-induced hypokalemia is due to beta2-adrenoceptor stimulation, and whether hypokalemia can occur at physiologic concentrations of the agonist, epinephrine was infused into six normal volunteers at a rate of 0.1 microgram per kilogram of body weight per minute. The circulating epinephrine concentration was increased to 1.74 +/- 0.65 ng per milliliter, plasma potassium was reduced by 0.82 +/- 0.19 meq per liter, plasma insulin fell by 12 +/- 4 mU per liter, plasma renin activity was elevated, and tachycardia occurred. Isoproterenol infused at 0.02 micrograms per kilogram per minute caused similar tachycardia (25 beats per minute) and elevation in plasma renin activity (6.0 to 6.5 ng per milliliter per hour), but no hypokalemia. The difference in responses to the two catecholamines was ascribed to the relative beta2-selectivity of epinephrine. This hypothesis was tested in six subjects given infusions of epinephrine (0.05 micrograms per kilogram per minute) after administration of either 2.5 or 5 mg of ICI 118551--a selective beta2-receptor antagonist--or placebo. After placebo, epinephrine infusion elevated the circulating epinephrine concentration and reduced plasma potassium; hypokalemia was prevented by the beta2-antagonist. This drug only partially inhibited the rises in plasma renin and glucose and the shortening of systolic time intervals; there was no tachycardia. Fifteen-fold to 30-fold increases in circulating epinephrine concentration appear to cause hypokalemia by a specific beta2-receptor effect distinct from other actions of epinephrine. This phenomenon may be of physiologic importance after severe myocardial infarction, when similar increases in plasma epinephrine have occurred.
This article has been cited by other articles:
Shiang, J.-C., Cheng, C.-J., Tsai, M.-K., Hung, Y.-J., Hsu, Y.-J., Yang, S.-S., Chu, S.-J., Lin, S.-H.
(2009). Therapeutic analysis in Chinese patients with thyrotoxic periodic paralysis over 6 years. Eur J Endocrinol
161: 911-916
[Abstract][Full Text]
Weinberg, J. M., Appel, L. J., Bakris, G., Gassman, J. J., Greene, T., Kendrick, C. A., Wang, X., Lash, J., Lewis, J. A., Pogue, V., Thornley-Brown, D., Phillips, R. A., for the African American Study of Hypertension and,
(2009). Risk of Hyperkalemia in Nondiabetic Patients With Chronic Kidney Disease Receiving Antihypertensive Therapy. Arch Intern Med
169: 1587-1594
[Abstract][Full Text]
Dunser, M. W., Hasibeder, W. R.
(2009). Sympathetic Overstimulation During Critical Illness: Adverse Effects of Adrenergic Stress. J Intensive Care Med
24: 293-316
[Abstract]
Gheeraert, P. J., De Buyzere, M. L., Taeymans, Y. M., Gillebert, T. C., Henriques, J. P.S., De Backer, G., De Bacquer, D.
(2006). Risk factors for primary ventricular fibrillation during acute myocardial infarction: a systematic review and meta-analysis. Eur Heart J
27: 2499-2510
[Abstract][Full Text]
Evans, K. J., Greenberg, A.
(2005). Hyperkalemia: A Review. J Intensive Care Med
20: 272-290
[Abstract]
The CREATE-ECLA Trial Group Investigators*,
(2005). Effect of Glucose-Insulin-Potassium Infusion on Mortality in Patients With Acute ST-Segment Elevation Myocardial Infarction: The CREATE-ECLA Randomized Controlled Trial. JAMA
293: 437-446
[Abstract][Full Text]
Lin, S.-H.
(2005). Thyrotoxic Periodic Paralysis. Mayo Clin Proc.
80: 99-105
[Abstract]
MacDonald, J. E., Struthers, A. D.
(2004). Serum potassium level and risk of postoperative atrial fibrillation in patients undergoing cardiac surgery": Reply. J Am Coll Cardiol
44: 939-939
[Full Text]
Nakamura, A., Imaizumi, A., Yanagawa, Y., Kohsaka, T., Johns, E. J.
(2004). {beta}2-Adrenoceptor Activation Attenuates Endotoxin-Induced Acute Renal Failure. J. Am. Soc. Nephrol.
15: 316-325
[Abstract][Full Text]
Macdonald, J. E., Struthers, A. D.
(2004). What is the optimal serum potassium level in cardiovascular patients?. J Am Coll Cardiol
43: 155-161
[Abstract][Full Text]
Shimizu, W., Noda, T., Takaki, H., Kurita, T., Nagaya, N., Satomi, K., Suyama, K., Aihara, N., Kamakura, S., Sunagawa, K., Echigo, S., Nakamura, K., Ohe, T., Towbin, J. A., Napolitano, C., Priori, S. G.
(2003). Epinephrine unmasks latent mutation carriers with LQT1 form of congenital long-QT syndrome. J Am Coll Cardiol
41: 633-642
[Abstract][Full Text]
Foo, K, Sekhri, N, Deaner, A, Knight, C, Suliman, A, Ranjadayalan, K, Timmis, A D
(2003). Effect of diabetes on serum potassium concentrations in acute coronary syndromes. Heart
89: 31-35
[Abstract][Full Text]
(2002). Hyperkalaemia in an elderly diabetic patient. Postgrad. Med. J.
78: 57-57
[Full Text]
Rastergar, A, Soleimani, M
(2001). Hypokalaemia and hyperkalaemia. Postgrad. Med. J.
77: 759-764
[Abstract][Full Text]
Alamoudi, O. S. B.
(2001). Electrolyte Disturbances in Patients With Chronic, Stable Asthma : Effect of Therapy. Chest
120: 431-436
[Abstract][Full Text]
Madias, J. E., Shah, B., Chintalapally, G., Chalavarya, G., Madias, N. E.
(2000). Admission Serum Potassium in Patients With Acute Myocardial Infarction : Its Correlates and Value as a Determinant of In-Hospital Outcome. Chest
118: 904-913
[Abstract][Full Text]
Brodde, O.-E., Michel, M. C.
(1999). Adrenergic and Muscarinic Receptors in the Human Heart. Pharmacol. Rev.
51: 651-690
[Abstract][Full Text]
Smith, J C, Meehan, C, Lyons, P, Robinson, A M
(1999). A man presenting with limb weakness and electrolyte imbalance. Postgrad. Med. J.
75: 691-693
[Full Text]
Guo, P., Pugsley, M.K., Yong, S.L., Walker, M.J.A.
(1999). Cardiac transplantation does not effect ischaemia-induced arrhythmias in rats. Cardiovasc Res
43: 930-938
[Abstract][Full Text]
Viscomi, C. M., Ptacek, L. J., Dudley, D.
(1999). Anesthetic Management of Familial Hypokalemic Periodic Paralysis During Parturition. Anesth. Analg.
88: 1081-1082
[Full Text]
Stein, C. M., He, H. B., Wood, A. J. J.
(1998). Basal and Stimulated Sympathetic Responses After Epinephrine : No Evidence of Augmented Responses. Hypertension
32: 1016-1021
[Abstract][Full Text]
Robbins, I. M., Cuiper, L. L., Stein, C. M., Wood, A. J. J., He, H. B., Parker, R., Christman, B. W.
(1998). Angiotensin II mediates systemic rebound hypertension after cessation of prostacyclin infusion in sheep. J. Appl. Physiol.
85: 731-737
[Abstract][Full Text]
Stein, C. M., Nelson, R., He, H. B., Wood, M., Wood, A. J. J.
(1997). Norepinephrine Release in the Human Forearm : Effects of Epinephrine. Hypertension
30: 1078-1084
[Abstract][Full Text]
Madias, J. E., Sheth, K., Choudry, M. A., Berger, D. O., Madias, N. E.
(1996). Admission Serum Magnesium Level Does Not Predict the Hospital Outcome of Patients With Acute Myocardial Infarction. Arch Intern Med
156: 1701-1708
[Abstract]
Minton, N., Henry, J.
(1996). Acute and chronic human toxicity of theophylline. Hum Exp Toxicol
15: 471-481
Brown, M. J
(1995). To (ss) block or better block?. BMJ
311: 701-702
[Full Text]
Skorodin, M. S.
(1993). Pharmacotherapy for Asthma and Chronic Obstructive Pulmonary Disease: Current Thinking, Practices, and Controversies. Arch Intern Med
153: 814-828
[Abstract]
Gretler, D. D., Elliott, W. J., Moscucci, M., Childers, R. W., Murphy, M. B.
(1992). Electrocardiographic Changes During Acute Treatment of Hypertensive Emergencies With Sodium Nitroprusside or Fenoldopam. Arch Intern Med
152: 2445-2448
[Abstract]
Callaham, M., Barton, C. W., Kayser, S.
(1991). Potential Complications of High-Dose Epinephrine Therapy in Patients Resuscitated From Cardiac Arrest. JAMA
265: 1117-1122
[Abstract]
Tyrer, P., Marsden, C., Ferguson, B., Murphy, S., Hannon, S., Greenwood, D.
(1991). Clinical and humoral effects of beta-blockade with ICI 118,551 in the general neurotic syndrome. J Psychopharmacol
5: 238-242
[Abstract]
Streeten, D. H. P., Anderson, G. H. Jr, Lebowitz, M., Speller, P. J.
(1990). Primary Hyperepinephrinemia in Patients Without Pheochromocytoma. Arch Intern Med
150: 1528-1533
[Abstract]
Hansen, O., Johansson, B. W., Nilsson-Ehle, P.
(1990). Metabolic, Electrocardiographic, and Hemodynamic Responses to Increased Circulating Adrenaline: Effects of Selective and Nonselective Beta Adrenoceptor Blockade. ANGIOLOGY
41: 175-188
Shannon, M., Lovejoy, F. H. Jr
(1989). Hypokalemia After Theophylline Intoxication: The Effects of Acute vs Chronic Poisoning. Arch Intern Med
149: 2725-2729
[Abstract]
Brady, H. R., Ryan, F., Cunningham, J., Tormey, W., Ryan, M. P., O'Neill, S.
(1989). Hypophosphatemia Complicating Bronchodilator Therapy for Acute Severe Asthma. Arch Intern Med
149: 2367-2368
[Abstract]
Almond, D.J., King, R.F.G.J., Burkinshaw, L., Laughland, A., Mcmahon, M.J.
(1989). Influence of Energy Source upon Body Composition in Patients Receiving Intravenous Nutrition. JPEN J Parenter Enteral Nutr
13: 471-477
[Abstract]
Allon, M., Dunlay, R., Copkney, C.
(1989). Nebulized Albuterol for Acute Hyperkalemia in Patients on Hemodialysis. ANN INTERN MED
110: 426-429
[Abstract]
SALERNO, D. M.
(1988). Postresuscitation Hypokalemia in a Patient with a Normal Prearrest Serum Potassium Level. ANN INTERN MED
108: 836-837
[Abstract]
D'Angio, R., Sabatelli, F.
(1987). Management Considerations in Treating Metabolic Abnormalities Associated With Theophylline Overdose. Arch Intern Med
147: 1837-1838
[Abstract]
Montoliu, J., Lens, X. M., Revert, L.
(1987). Potassium-Lowering Effect of Albuterol for Hyperkalemia in Renal Failure. Arch Intern Med
147: 713-717
[Abstract]
Kafka, H., Langevin, L., Armstrong, P. W.
(1987). Serum Magnesium and Potassium in Acute Myocardial Infarction: Influence on Ventricular Arrhythmias. Arch Intern Med
147: 465-469
[Abstract]
Hill, N. S.
(1986). Fluid and Electrolyte Considerations in Diuretic Therapy for Hypertensive Patients With Chronic Obstructive Pulmonary Disease. Arch Intern Med
146: 129-133
[Abstract]
HALL, K. W., DOBSON, K. E., DALTON, J. G., GHIGNONE, M. C., PENNER, S. B.
(1984). Metabolic Abnormalities Associated with Intentional Theophylline Overdose. ANN INTERN MED
101: 457-462
[Abstract]
Previous
