Hyperkalaemia in the emergency department: Epidemiology, management and monitoring of treatment outcomes

Abstract

Objective: To describe the epidemiology, treatment and monitoring of treatment outcomes of patients presenting to the ED with hyperkalaemia. Methods: We undertook a retrospective observational study in a mixed adult/paediatric ED over five 3-month periods. Consecutive patients were included if they had an initial serum or blood gas potassium ≥6.0 mmol/L. Patients were excluded if their principal diagnosis was diabetic ketoacidosis, their blood sample was haemolysed or the blood gas result was inconsistent with a subsequent serum potassium. Data were extracted from electronic medical records and two senior emergency registrars independently assessed available ECGs. Moderate and severe hyperkalaemia were potassium 6.0-6.4 and ≥6.5 mmol/L, respectively. Results: Overall, 392 patients were included (mean age 73.7 years, triage category 1 or 2 28.3%, admitted 91.3%). Three hundred and twentyone (81.9%, 95% confidence interval [CI] 77.6-85.5%) patients took one or more medications that predis-pose to hyperkalaemia and 335 (85.5%, 95% CI 81.5-88.7%) had one or more predisposing comorbidities. Two hundred and seventyone (69.1%, 95% CI 64.3-73.6%) patients had moderately severe and 121 (30.9%, 95% CI 26.4-35.7%) had severe hyperkalaemia. Two hundred and fifty-nine (66.1%, 95% CI 61.1-70.7%) patients were administered at least one medication in ED to lower the potassium concentration and 51 (13.0%, 95% CI 9.9-16.8%) were dialysed. One hundred and eighty-seven patients received intravenous insulin: 40 (21.4%) had documented biochemical hypoglycaemia, but 45 (24.1%) had no post-insulin blood glucose level documented. Hyperkalaemia-associated ECG changes were uncommon. Conclusion: Most ED patients with hyperkalaemia have identifiable clinical and medication-related risk factors. Variations in care were widespread and monitoring for iatrogenic adverse events was suboptimal.

Response to Re: Hyperkalaemia in the emergency department: Epidemiology, management and monitoring of treatment outcomes

“…Response to Re: Hyperkalaemia in the emergency department: Epidemiology, management and monitoring of treatment outcomes Dear Editor, We thank Brož et al 1 for their feedback regarding our observational study of hyperkalaemia management in the ED. 2 As noted in their letter, 187 of the 392 patients in our study received i.v. insulin as part of their hyperkalaemia management, and 40 of these patients developed documented biochemical evidence of hypoglycaemia, when defined as a blood glucose level (BGL) of ≤3.9 mmol/L.…”

Evaluation of Causes of Hyperkalemia in Systemic Lupus Erythematosus Patients: Retrospective Single-Center Experience

“…Yeni yayınlanan bir metaanalizde tüm yetişkin populasyonunda hiperkalemi prevalansının (herhangi bir tanım/eşik ile) %6.3 ve insidansının ise 100 hasta yılı başına 2.8 (2,3-3.3) olduğu saptanmıştır (8). Acil servise başvuran ve başlangıç serum veya kan gazı potasyumu ≥6.0 mmol/L olan hastaların değerlendirildiği başka bir çalışmada ise tüm başvurular dahil edildiğinde hiperkalemi prevelansı %0.4 saptanmıştır (10). Hiperkalemi için serum potasyum düzeyini ≥ 5.5 mmol/L olarak alan 468.594 yetişkin arasında (2012-2014 yılları) en az bir kez potasyum bakılmış olan hastaların takip edildiği bir çalışmada ise hiperkalemi yıllık insidansı 100 kişide 1 olarak saptanmıştır.…”

Implications of differences between point‐of‐care blood gas analyser and laboratory analyser potassium results on hyperkalaemia diagnosis & treatment

“…Hyperkalaemia has been reported in up to 10% of hospitalised patients and 0.3% to 0.4% of patients presenting to an emergency department (ED), depending upon the specific population studied 1–7 . It is an electrolyte disturbance associated with potentially life‐threatening cardiac dysrhythmias and significantly increased in‐hospital mortality compared to patients with normokalaemia 7 .…”