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(Chest. 1994;106:1654-1659.)
© 1994 American College of Chest Physicians

Potassium and Magnesium Distribution, ECG Changes, and Ventricular Ectopic Beats During β2-Adrenergic Stimulation With Terbutaline in Healthy Subjects

Claus Tveskov M.D.1; Mogens Stig Djurhuus M.D.1; Niels Anders Holm Klitgaard Ph.D.1; and Kenneth Egstrup Ph.D.1

1 From the Department of Cardiology and Department of Clinical Chemistry, Odense University Hospital, Odense, Denmark

Objective: To study the effect of intravenous (IV) terbutaline on potassium (K) and magnesium (Mg) distribution, ECG changes, and prevalence of ventricular ectopic beats in healthy subjects.

Design: Randomized double-blind, placebo-controlled crossover. Subjects received either placebo or terbutaline (bolus, 0.25 mg; maintenance dose, 5 µg/min).

Setting: University Department of Clinical Chemistry.

Participants: Ten healthy male volunteers. Mean age was 24.1 (range, 20 to 31) years.

Main outcome measures: Serum potassium and magnesium, muscle potassium and magnesium, and muscle sodium-potassium pump number. Urinary excretion of potassium and magnesium. ECG changes (T-wave and QTC interval) and the number of ventricular ectopic beats.

Main results: Terbutaline produced an immediate decrease in serum potassium level from 4.17 (4.04 to 4.30) mmol/L to a nadir of 3.32 (3.06 to 3.58) mmol/L (p<0.001). The urinary excretion of potassium decreased from 0.077 mmol/min (0.052 to 0.102) to 0.038 mmol/min (0.025 to 0.051) (p<0.01). There was an increase in the number of sodium potassium pumps from 1,104.1 nmol/kg dry weight (1,030.6 to 1,177.5) to 1,273.3 nmol/kg dry weight (1,193.5 to 1,353.2) (p< 0.01), but no measurable change in muscle potassium. The QTC interval increased from 395 (385 to 405) ms to 449 (432 to 466) ms (p< 0.003). There was no change in the number of ventricular ectopic beats.

Conclusion: Short-term IV administration of terbutaline produced hypokalemia partly due to an increase in the number of sodium-potassium pumps. Furthermore, terbutaline induced changes in ECG with a highly significant lengthening of the QTc interval but with an unchanged number of ventricular ectopic beats in healthy subjects.

Key Words: adrenergic beta-receptor-agonists • arrhythmias • magnesium • potassium • QT-interval • sodium-potassium pumps • terbutaline

Submitted on November 16, 1993
Accepted on March 1, 1994




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