Amiodarone attenuates fluoride-induced hyperkalemia in vitro

Mark Su, Jason Chu, Mary Ann Howland, Lewis S. Nelson, Robert S. Hoffman

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Poisoning by hydrofluoric acid or fluoride salts results in hypocalcemia, hypomagnesemia, and hyperkalemia with subsequent cardiac dysrhythmias. In previous studies, quinidine attenuated fluoride-induced hyperkalemia in vitro, and enhanced survival in animals. Like quinidine, amiodarone is a potassium channel blocker, although amiodarone is more familiar to clinicians due to its recent inclusion in advanced cardiac life support (ACLS) protocols. Objectives: This in-vitro study of human erythrocytes was designed to determine whether amiodarone could attenuate fluoride-induced hyperkalemia. Methods: Six healthy volunteers each donated 60 mL of blood on three occasions. Each specimen was divided into 12 tubes, incubated at 37°C, and oxygenated with room air. An aqueous sodium fluoride (F-) solution was added to tubes 1-9. Incremental amounts of quinidine were added to tubes 1-4 (Q1-Q4) to attain calculated concentrations of 0.73 μg/mL, 1.45 μg/mL, 2.9 μg/mL, and 5.8 μg/mL, respectively. Incremental amounts of amiodarone were added to tubes 5-8 (A1-A4) to attain calculated concentrations of 0.38 μg/mL, 0.75 μg/mL, 1.5 μg/mL, and 3.0 μg/mL, respectively. Tubes 9-12 were controls for each of F-, amiodarone, quinidine alone, and no additive, respectively. Extracellular potassium concentration ([K+]) was followed, and an objective endpoint was defined as the rise in potassium concentration at 6 hours. Results: Fluoride produced a significant change in [K+] by 6 hours in all samples. Quinidine produced a J-shaped curve in its ability to attenuate the rise in [K+], with only one concentration, Q3, demonstrating significance versus tube 9 (control). Amiodarone also demonstrated a J-shaped dose-response effect, with statistical significance at A1, A2, and A3 versus tube 9 (control). There was no significant difference among the effective concentrations (Q3, A1, A2, and A3) of both drugs. Conclusions: In this in-vitro model using human blood, amiodarone and quinidine both attenuated F--induced hyperkalemia. Further study is indicated to determine whether amiodarone enhances survival in F--poisoned animals.

Original languageEnglish
Pages (from-to)105-109
Number of pages5
JournalAcademic Emergency Medicine
Issue number2
StatePublished - 1 Feb 2003
Externally publishedYes


  • Amiodarone
  • Fluoride
  • Hyperkalemia
  • Potassium
  • Quinidine


Dive into the research topics of 'Amiodarone attenuates fluoride-induced hyperkalemia in vitro'. Together they form a unique fingerprint.

Cite this