Predictors of Outcome in Patients Presenting with Moderate to Severe Hyperkalemia

Abstract

IntroductionIn previous literature, hyperkalemia is defined as serum potassium (K+) concentration greater than 5.5 mEq/dL which is very common in patients visiting Emergency rooms, and mostly associated with adverse clinical outcomes [1][2][3][4]. Its prevalence and clinical impact in critically ill Emergency Department (ED) patients is not fully discovered yet but it is thought to occur in 1-10% of patients admitted to the hospital [5]. Majority of the patients have underlying end-stage renal disease, which causes decreased excretion of dietary potassium, chronic asymptomatic, hyperkalemia, or metabolic acidosis induced extracellular shift of potassium leading to acute hyperkalemia [6][7][8]. Although the condition is associated with a variety of clinical presentations, EKG manifestations of hyperkalemia are generally progressive and proportional to the serum K+ and ventricular arrhythmias may be the first EKG finding of hyperkalemia. Sometimes, however, normal EKG may be seen even with very high serum potassium levels [1][2][3]9]. The management of hyperkalemia also depends on an understanding of the underlying physiology, cause of hyperkalemia and plasma potassium levels. Treatment is aimed at restoring normal potassium balance, preventing life threatening complications and treating the underlying causes [8,10,11]. Generally authorities consider that serum K+ concentration of greater than 6.0mEq/dL with ECG changes, or greater than 6.5 mEq/ dL regardless of the ECG, represents severe hyperkalemia that warrants urgent treatment [11,12]. Despite many patients presenting to EDs in critical condition, predictors of clinical outcomes such as in-hospital mortality have not been well studied [12]. We therefore introduce this study to identify common factors associated with moderate to severe hyperkalemia and to analyze the relationship between serum K+ levels and clinical outcomes, including in-hospital mortality. AbstractIntroduction: One of the most common electrolyte imbalance observed in Emergency Departments (ED) is hyperkalemia [Potassium (K) level >5.5 mEq/dL]. Moderate to severe hyperkalemia (K level >6.0 mEq/ dL) may cause serious arrhythmias therefore it is important to correct hyperkalemia promptly and treat the underlying cause.

The Incredible Breadth of Emergency Medicine

“…We are forced to develop "diagnostic and therapeutic algorithm for the hypoperfused patient with septic shock in the emergency department" and do not simply borrow from other specialists who treat such patients [5]. Many patients with hyperkalemia are saved or lost in the emergency department and we study "Predictors of Outcome in Patients Presenting with Moderate to Severe Hyperkalemia" [6]. Anaphylaxis occurring in the general population, especially for the first time, presents to emergency physicians who are responsible to know pathophysiology and multiple treatment options [1].…”