Potassium and phosphorus repletion in hospitalized patients: implications for clinical practice and the potential use of healthcare information technology to improve prescribing and patient safety

Hemstreet, Brian A.; Stolpman, Nancy M.; Badesch, David B.; May, Sondra K.; McCollum, Marianne

doi:10.1185/030079906x148463

Cited by 24 publications

(19 citation statements)

References 32 publications

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“…Currently, there is no randomized controlled evidence or consensus as to the optimal serum phosphate target in critically ill patients [29]. Hypophosphatemia was generally corrected if it was symptomatic or severe [17, 30], with phosphate repletion to achieve physiological levels [31]. However, some authors contest that phosphate repletion based on serum levels may not correlate with intracellular concentrations and ATP synthesis [32].…”

Section: Discussionmentioning

confidence: 99%

Hypophosphatemia in critically ill patients with acute kidney injury treated with hemodialysis is associated with adverse events

2017

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Background. Hypophosphatemia in critically ill patients may be exacerbated by renal replacement therapy (RRT). We aimed to identify risk factors and adverse outcomes associated with hypophosphatemia in intensive care patients treated with RRT for acute kidney injury (AKI). Methods. This was a secondary analysis of data from a single-center prospective cohort study of medical and surgical intensive care patients with RRT for AKI between 18 December 2010 and 3 April 2013. Demographic, comorbidity, laboratory and RRT data were retrieved from patient case notes and electronic medical records. Outcomes assessed were hypophosphatemia (serum phosphate <0.94 mmol/L) during RRT, intensive care unit (ICU) mortality, and duration of mechanical ventilation and vasopressor support. Results. Among 96 patients who received acute RRT, 25 (26.0%) developed hypophosphatemia. On multivariate logistic regression, serum phosphate at RRT initiation [adjusted odds ratio (OR) 0.29, 95% confidence interval (CI) (0.09, 0.91), P = 0.03] was independently associated with hypophosphatemia during acute RRT. Patients with hypophosphatemia during RRT required longer ventilatory support [median 12 (interquartile range: 8, 17) days versus 5 (3, 9) days, P < 0.001] and vasopressor support [5 (4, 15) days versus 2 (2, 6) days, P = 0.003] compared with those without hypophosphatemia but there was no significant difference in ICU mortality [5 patients (20.0%) versus 24 patients (33.8%), P = 0.20]. Hypophosphatemia during RRT was independently associated with prolonged mechanical ventilation (≥7 days) [adjusted OR 14.0, 95% CI (1.37, 143.90), P = 0.03]. Conclusion. Hypophosphatemia is common during acute RRT for critically ill patients and was associated with adverse clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Hypophosphatemia in critically ill patients with acute kidney injury treated with hemodialysis is associated with adverse events

2017

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“…Remarkably, very few papers have explicitly described strategies how to regulate potassium in ICU patients [8-12,17,18,29]. Analogous to glucose control, potassium control may even be perceived as tedious.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there are no reports of a computerized potassium recommendation protocol in the ICU. Computer software is recognized as a tool to reduce serious medication errors and improve adherence to recommended care [13,14,17,30]. …”

Section: Discussionmentioning

confidence: 99%

Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit - a before and after analysis

Hoekstra

Vogelzang

Drost

et al. 2010

BMC Med Inform Decis Mak

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BackgroundPotassium disorders can cause major complications and must be avoided in critically ill patients. Regulation of potassium in the intensive care unit (ICU) requires potassium administration with frequent blood potassium measurements and subsequent adjustments of the amount of potassium administrated. The use of a potassium replacement protocol can improve potassium regulation. For safety and efficiency, computerized protocols appear to be superior over paper protocols. The aim of this study was to evaluate if a computerized potassium regulation protocol in the ICU improved potassium regulation.MethodsIn our surgical ICU (12 beds) and cardiothoracic ICU (14 beds) at a tertiary academic center, we implemented a nurse-centered computerized potassium protocol integrated with the pre-existent glucose control program called GRIP (Glucose Regulation in Intensive Care patients). Before implementation of the computerized protocol, potassium replacement was physician-driven. Potassium was delivered continuously either by central venous catheter or by gastric, duodenal or jejunal tube. After every potassium measurement, nurses received a recommendation for the potassium administration rate and the time to the next measurement. In this before-after study we evaluated potassium regulation with GRIP. The attitude of the nursing staff towards potassium regulation with computer support was measured with questionnaires.ResultsThe patient cohort consisted of 775 patients before and 1435 after the implementation of computerized potassium control. The number of patients with hypokalemia (<3.5 mmol/L) and hyperkalemia (>5.0 mmol/L) were recorded, as well as the time course of potassium levels after ICU admission. The incidence of hypokalemia and hyperkalemia was calculated. Median potassium-levels were similar in both study periods, but the level of potassium control improved: the incidence of hypokalemia decreased from 2.4% to 1.7% (P < 0.001) and hyperkalemia from 7.4% to 4.8% (P < 0.001). Nurses indicated that they considered computerized potassium control an improvement over previous practice.ConclusionsComputerized potassium control, integrated with the nurse-centered GRIP program for glucose regulation, is effective and reduces the prevalence of hypo- and hyperkalemia in the ICU compared with physician-driven potassium regulation.

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“…However, it has not been clear whether similar or distinct signaling pathways drive the development of the destructive versus remodeling lung pathologies in COPD lungs. A common feature of the pulmonary lesions associated with COPD is inflammation, and exaggerated T helper type 1 (Th1), Th2 cytokine, and Th17 responses have been linked to COPD pathogenesis (3)(4)(5)(6)(7). However, it has not been clear to what extent Th1, Th2, and Th17 cytokine responses contribute to individual pathologies in COPD lungs, or whether they interact synergistically or otherwise to promote the development of COPD.…”

Section: Discussionmentioning

confidence: 97%

“…This poses a serious risk of unnecessary harm to patients with acute liver failure, for whom there is no comparably effective therapy. Other problematic examples of habitual prescribing include use of certain intravenous antibiotics and electrolyte replacements (e.g., trimethoprim-sulfamethoxazole and potassium phosphate) rather than plentiful, equivalent oral agents (6,7). The risk of unnecessary harm to patients from shortages is sufficient ethical justification to attempt to influence physicians' prescribing behavior.…”

mentioning

confidence: 97%

Using Principles of Behavioral Economics to Mitigate Drug Shortages

Karir¹,

Kahn²,

White³

2012

Am J Respir Crit Care Med

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Potassium and phosphorus repletion in hospitalized patients: implications for clinical practice and the potential use of healthcare information technology to improve prescribing and patient safety

Cited by 24 publications

References 32 publications

Hypophosphatemia in critically ill patients with acute kidney injury treated with hemodialysis is associated with adverse events

Hypophosphatemia in critically ill patients with acute kidney injury treated with hemodialysis is associated with adverse events

Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit - a before and after analysis

Using Principles of Behavioral Economics to Mitigate Drug Shortages

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