Hypokalaemia in hospitalised patients.

QUESTIONS UNDER STUDY: Hypokalaemia in inpatients is common, and is associated with morbidity and mortality. Its management is risky and not always effective. We launched an educational programme with the aim of increasing the rate of potassium normalisation during hospital stay, and of reducing unmonitored cases. METHODS: The project consisted of three phases: (I) retrospective analysis on 26 471 patients hospitalised in 2012 in five acute care hospitals of southern Switzerland (Ente Ospedaliero Cantonale, EOC) with identification of improvement goals on a sample survey (588 cases of hypokalaemia); (II) revision of internal guidelines, and implementation of educational activities in one of the five hospitals (Ospedale Regionale di Locarno, ODL); (III) follow-up analysis on the 26 726 patients hospitalised in 2014 and second sampling to complete the evaluation of the efficacy of the intervention. RESULTS: Phase I, ODL vs EOC: prevalence of hypokalaemia, 21.7 vs 23.2% (p <0.05); treated 53.1 vs 56.5% (not significant); normalisation 62.4 vs 61.1% (ns); absence of monitoring 18.3 vs 21.1% (p <0.05); time to normalisation 3.0 ± 2.7 vs 2.8 ± 2.4 days (ns); secondary hyperkalaemia 1.1 vs 1.4% (ns). Length of stay hypokalaemic vs normokalaemic 11.2 ± 11.7 vs 6.6 ± 7.9 days (p <0.001); falls 3.5 vs 1.7% (p <0.001), deaths 5.1 vs 3.1% (p <0.001). The severity/performance ratio suggested inefficiency. Phase III, ODL 2012 vs ODL 2014: treated 53.1 vs 75.7% (p <0.001); normalisation 62.4 vs 69.7% (p <0.01); absence of monitoring 20.1 vs 8.7 (p <0.01); time to normalisation 3.1 ± 2.7 vs 2.4 ± 2.6 days (ns); secondary hyperkalaemia 1.1 vs 1.8% (ns). CONCLUSIONS: The management of hypokalaemia is characterised by dysfunctions; it can, however, be ameliorated by the implementation of internal guidelines and targeted educational activities. The length of hospital stay is increased in patients with hypokalaemia, shifting the expected length of hospital stay based on the Swiss Diagnosis Related Group classification.

Spontaneus small bowel volvulus in an adult. Case report and review of the literature.

BACKGROUND: We present a case of spontaneus small bowel volvulus in an adult patients who presented to the emergency department. In this case we had no obvious precipitating factors. AIMS: A man of 72 years, was transferred to our hospital after being examined and diagnosed with acute pain. Over the past two years has had four episodes of sharp epigastric pain radiating to the back half with associated nausea and vomiting. He is an alcoholic and heavy smoker. His medical history, blood, urine and biochemical data were all non-cotributory. An abdominal CT angiography, we noticed a swirling mass of mesenteric and small bowel with adjacent around the superior mesenteric artery. METHODS: A case of spontaneus volvulus of the small intestine in an adult with a review of the literature is reported. CONCLUSIONS: SBV is an uncommon but potentially serious cause of small bowel obstruction in Western countries, carrying an overall mortality rate of 10% to 35%. In the presence of gangrene, mortality is usually 40% or greater. Physicians should consider, in patients with obstruction of the small intestine where their pain is excessive and does not respond to treatment with narcotics analgesic the possibility of volvulus of the mesentery. If the diagnosis is suspected emergency surgical is necessary, conservation measures usually result in a higher rate of gangrene. Although no studies have identified an optimal surgical treatment, resection and primary anastomosis has been recommended in all cases.