Potassium abnormalities in current clinical practice: frequency, causes, severity and management

We aimed to investigate the prevalence and etiology of potassium abnormalities [hypokalemia and hyperkalemia] and management approaches for hospitalized patients. Over a 4-month period, all hospitalized patients at Hacettepe University Medical Faculty Hospitals who underwent at least one measurement of serum potassium during hospitalization were included. Data on serum levels of electrolytes, demographic characteristics, cause[s] of hospitalization, medications, etiology of potassium abnormality and treatment approaches were obtained from the hospital records. Of the 9,045 hospitalized patients, 1,265 [14.0%] had a serum potassium abnormality; 604 [6.7%] patients had hypokalemia and 661 [7.30%] had hyperkalemia. In the hypokalemic patients, the most important reasons were gastrointestinal losses in 555 [91.8%] patients and renal losses in 252 [41.7%] patients. The most frequent treatment strategies were correcting the underlying cause and replacing the potassium deficit. Of the 604 hypokalemic patients, 319 [52.8%] were normokalemic at hospital discharge. The most common reason for hyperkalemia was treatment with renin-angiotensin-aldosterone system blockers in 228 [34.4%] patients, followed by renal failure in 191 [28.8%]. Two hundred and ninety-eight [45.0%] patients were followed without any specific treatment. Of the 661 hyperkalemic patients, 324 [49.0%] were normokalemic at hospital discharge. This study showed a high prevalence of potassium imbalance among hospitalized patients. Although most of the potassium abnormalities were mild/moderate, approximately half of the patients treated for hypokalemia or hyperkalemia were discharged from the hospital with ongoing dyskalemia

Frequency of dysnatremia and dyskalemia in cardiac surgical intensive care unit

To determine the frequency of dysnatremia and dyskalemiain cardiac surgical intensive care unit patients and to identify the factors associated with the changes in potassium and sodium levels. Cross Sectional study. Cardiac surgical intensive care unit [ICU] of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from July 2013 to November 2013. Post-operative patients in cardiac surgical intensive care unit were selected through non probability convenient sampling. Demographic and clinical data was collected for all patients including: age, sex etc. Additionally, laboratory data such as potassium and sodium serum concentrations were recorded of day one of the first five post operative days. Out of 100 patients, 51% had dyskalemia, 33% had episodes of hypokalemia, and 19% had hyperkalemia. On the other hand 79% patients had dysnatremia, among them 71%had hyponatremia, and 8% had hypernatremia. Dyskalemia and dysnatremia are common problems in cardiac surgical ICU with higher frequency of hyponatremia as compared to hypernatremia, and hypokalemia as compared to hyperkalemia

Associação entre hipopotassemia, desnutrição e mortalidade em pacientes em diálise peritoneal contínua / Association between hypokalemia, malnutrition and mortality in peritoneal dialysis patients

INTRODUÇÃO: A hipopotassemia pode ser um problema grave e promover a mortalidade de pacientes em diálise peritoneal (DP). Vários fatores podem desencadear a hipopotassemia nesses pacientes, como a desnutrição pré-existente, a baixa ingestão alimentar de proteínas e de potássio, e o uso de certos medicamentos. OBJETIVOS: Verificar a prevalência da hipopotassemia e sua associação com a mortalidade, estado nutricional, indicadores clínicos, testes laboratoriais e eletrocardiograma em pacientes em diálise peritoneal. MÉTODOS: Este foi um estudo observacional. Um questionário foi aplicado para identificar seis sinais e sintomas associados à hipopotassemia (definida como potássio sérico < 3,5 mEq/L). O estado nutricional foi avaliado pela avaliação subjetiva global (SGA) e pelo índice de massa corporal (IMC). Dados demográficos, testes laboratoriais, características da diálise e taxa de sobrevida foram coletados. Também foi realizada a análise de eletrocardiograma. RESULTADOS: Dos 110 pacientes avaliados, a hipopotassemia foi detectada em 13,6% (n = 15). A sobrevida foi menor no grupo hipocalêmico (p = 0,002). A hipopotassemia teve associação significativa somente com a albumina e ureia séricas, e com os resultados da SGA. CONCLUSÃO: Baixos níveis de potássio sérico foram associados com pior sobrevida em pacientes em DP e pareceu estar relacionada à desnutrição.

INTRODUCTION: Hypokalemia is found in peritoneal dialysis (PD) patients. The problem may be severe and promote mortality. Several factors may trigger the hypokalemia in PD patients, such as preexisting malnutrition and the low protein and potassium food intake. OBJECTIVES: To verify the prevalence of hypokalemia and its association with mortality, nutrition status, clinical, laboratory and electrocardiographic variables in PD patients. METHODS: Serum K+ levels were evaluated retrospectively in PD patients. Hypokalemia was defined when the average of serum K+ was < 3.5 mEq/L in six consecutive measurements. Other available biochemical tests were also evaluated. Subjective Global Assessment (SGA) and body mass index (BMI) were used to assess the nutrition status. A questionnaire was applied to identify the most common symptoms and signals associated to hypokalemia. An electrocardiogram was performed. Demographic data, dialysis characteristics and survival rate were collected. RESULTS: Hypokalemia was present in 15 out of 110 patients (13.6%). The survival rate was lower in the hypokalemic group (p = 0.002). Hypokalemia was only associated with serum levels of albumin and urea, and with the SGA results. CONCLUSION: Low levels of serum potassium were associated to lower survival in PD patients and it seems to be related to malnutrition.

Serum urea, creatinine and electrolyte status in patients presenting with acute gastroenteritis.

The present study was undertaken to estimate the serum urea, creatinine and electrolyte status of patients presenting with acute gastroenteritis. Sixty patients who presented to Kathmandu Medical College and Teaching hospital from 15 June to 15 July 2005 with acute diarrhea with or without associated vomiting, causing dehydration severe enough to require hospital admission were investigated for serum urea, creatinine and electrolyte level. Out of 60 patients investigated, serum sodium and potassium level were available for 34 patients. Only one (2.9%) patients had sodium level below 135mEq/l, thirty two (94.11%) had sodium level between 135-146 mEq/l and one (2.9%) had sodium level above 146mEq/l. Similarly 9 (26.47%) patients had potassium level below 3.5mEq/l, 22 (64.70%) patients had potassium level between 3.5-5 mEq/l and 3 (8.82%) patients had level above 5 mEq/l. Serum urea and creatinine level were available for 47 patients. 36 (76.59%) patients had serum urea level between 15-45mg/dl and 11 (23.40%) patients had urea level above 45 mg/dl. 35 (74.46%) patients had serum creatinine level between 0.5-1.4 mg/dl and 12 (25.53%) had serum creatinine level above 1.4 mg/dl. In this study hypokalaemia was noticed more than hyponatremia and significant number of patients also showed increased level of serum urea and creatinine. Therefore, serum urea, creatinine and electrolytes should be closely monitored in patients with acute gastroenteritis.

Hypokalemia in a pediatric intensive care unit.

OBJECTIVE: To examine the frequency, severity, risk factors and mortality of hypokalemia, and efficacy of therapy used for its correction. DESIGN: Descriptive, retrospective analysis. SAMPLE: 290 patient records admitted consecutively to a Pediatric Intensive Care Unit (PICU) over a period of one year. RESULTS: Forty three (14.8%) patients had 54 episodes of hypokalemia. Predisposing factors included the nature of primary disease (renal disease 19%, septicemia 19%, acute diarrhea 14%, heart disease with congestive failure, and meningoencephalitis 12% each), malnutrition (weight for age less than 80% in 72%) and therapy with drugs (diuretics, corticosteroids and antiasthma drugs). For correction of hpokalemia all the patients received 4-6 mEq potassium per 100 ml of intravenous fluids (slow correction). Seven patients (9 episodes), with ECG changes of hpokalemia, also received infusion of 0.3 mEq potassium/kg/hour till ECG became normal (rapid correction). Normal potassium level was achieved in all nine episodes where rapid correction was given, and in 40 of 45 episodes which received slow correction. The overall mortality among patients with hypokalemia (25.6%, 11/43) was significantly higher than that among the remaining PICU patients (10.9%, 27/247; odd's ratio 2.34; 95% confidence interval 1.3-4.2) (p < 0.05). All the patients receiving rapid correction survived. CONCLUSIONS: Hypokalemia is a common problem among PICU patients. Early detection through regular monitoring and rapid correction may help in improving the outcome.

Alteraçöes hidroeletrolíticas, ácido-básicas e da funçäo renal em pacientes portadores da síndrome da imunodeficência adquirida / Hydroelectrolyte changes, acid-base and renal function in patients carrier acquired immunodeficiency syndrome

OBJETIVO. Avaliar a influência no curso clínico e a prevalência de distúrbios hidroeletrolíticos, ácido-básicos e da funçäo renal em pacientes portadores da síndrome da imunodeficiência adquirida (SIDA). Casuística e Métodos. A partir de um protocolo preestabelecido, revisaram-se os prontuários da primeira internaçäo de todos os pacientes admitidos durante o primeiro semestre de 1989. RESULTADOS. Noventa e nove pacientes foram estudados. A prevalência de hiponatremia, no momento da baixa, foi de 45% e durante a internaçäo, de 80,7% dos pacientes avaliados. Hipopotassemia esteve presente em 23,1% dos pacientes e acidose metabólica e insuficiência renal em 20,1 e 28,4%, respectivamente. O risco relativo para mortalidade em pacientes com hipopotassemia foi 4,4. Acidose metabólica e insuficiência renal aguda apresentaram riscos relativos de 12,9 e 21,4. Estes fatores, hipopotassemia (p < 0,01), acidose metabólica (p < 0,001) e insuficiência renal aguda (p < 0,001), estiveram significativamente associados à mortalidade. DISCUSSÄO E CONCLUSOES. Conclui-se que existe uma elevada prevalência das alteraçöes avaliadas nos pacientes com SIDA e que o desenvolvimento de hipopotassemia, acidose metabólica e insuficiência renal aguda está significativamente associado à mortalidade nestes pacientes

Rabdomiolisis e insuficiencia respratoria aguda hipodinámica debido a hipokalemía severa. Presentación de un caso / Rhabdomyolysis and acute respiratory insufficiency owing to severe hypodinamic. Report of a case

La hipokalemia es un trastorno electrolítico muy común en los pacientes críticos y es a su vez una causa establecida de rabdomiolisis tanto en humanos como en animales de laboratorio. Aunque su prevalencia en pacientes con hipokalemia no se conoce, parece ser que la rabdomiolisis e insuficiencia respiratoria aguda hipodinámica debida a hipokalemia severa secundaria a una acidosis tubular renal tipo I