Hyperkalemia in the Emergency Department: Urgent Need for a Rigorous Evaluation of the First-Line Treatments

Lemoine, L.; Chouihed, Tahar; Legrand, Matthieu; Rossignol, Patrick; Potel, G.; Montassier, Emmanuel

doi:10.1016/j.jemermed.2018.11.024

Cited by 1 publication

(3 citation statements)

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“…Lemoine et al 5 . found similar variability in hyperkalaemia management ‘without obvious rationale’ in their survey of French emergency physicians 7 . Similarly, Peacock et al .…”

Section: Discussionmentioning

confidence: 81%

“…Lemoine et al 5 found similar variability in hyperkalaemia management 'without obvious rationale' in their survey of French emergency physicians. 7 Similarly, Peacock et al found that in 203 patients who presented to 14 US EDs, a total of 43 different treatment combinations were used. 12 Guidelines, algorithms or checklists may be useful to provide management recommendations, particularly for junior clinicians, and to improve consistency of care.…”

Section: Discussionmentioning

confidence: 99%

“…Hyperkalaemia management options include a multi-faceted approach to ultimately stabilise the cardiac membrane, temporarily shift potassium into the intracellular space, increase potassium excretion via renal or gastrointestinal mechanisms and removal via dialysis or haemofiltration. 5,7 Careful and timely monitoring of treatment outcomes is important to adequately treat hyperkalaemia and to recognise and act on complications. The evidence base to guide therapeutic management comprises mostly small studies, although a larger randomised controlled trial is ongoing.…”

Section: Introductionmentioning

confidence: 99%

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

Pollack

Manning

Balassone

et al. 2022

Emerg Medicine Australasia

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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.

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“…Lemoine et al 5 . found similar variability in hyperkalaemia management ‘without obvious rationale’ in their survey of French emergency physicians 7 . Similarly, Peacock et al .…”

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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