Incidence, characteristics and outcomes among inpatient, outpatient and emergency department with reported high critical serum potassium values
Author:
Kuo Wei-Hung1, You Huey-Ling2, Huang Wan-Ting2, Lee Yueh-Ting1, Chiou Terry Ting-Yu13, Ng Hwee-Yeong1, Lee Chien-Te1
Affiliation:
1. Division of Nephrology, Department of Internal Medicine , Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine , Kaohsiung , Taiwan 2. Department of Laboratory Medicine , Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine , Kaohsiung , Taiwan 3. School of Medicine , Chung Shan Medical University , Taichung , Taiwan
Abstract
Abstract
Objectives
Severe hyperkalemia can cause life-threatening arrhythmia, cardiac arrest, or death. This study aimed to investigate the incidence and the associated factors relevant to critical hyperkalemia (≥6 mmol/L) among inpatients, outpatients, and emergency department. Their clinical outcomes were also analyzed.
Methods
All patients whose high serum potassium values had been reported as critical laboratory values in 2016 were enrolled. Their demographic data, comorbidities, clinical symptoms, biochemical data, and outcomes were reviewed and collected. The Charlson comorbidity score (CCS) and glomerular filtration rate (GFR) were computed to assess the comorbidity burden and renal function. Patients were divided into groups according to different settings, potassium and GFR levels, and their survival.
Results
Of the 293,830 total serum potassium tests, 1,382 (0.47%) reports were listed as critical laboratory values. The average reply time was 6.3 min. Their mean age was 67.2 years, while the average GFR was 12.2 mL/min/1.73 m2. The overall mortality rate was 34%. Patients in the emergency department had the highest incidence (0.92%), while inpatients had the worst outcome (51% mortality). The leading cause of mortality was septic shock. The fatal group had higher rates of clinical symptoms, higher potassium values, CCS, and eGFR (all p<0.05).
Conclusions
Most of the responses for the reports were obtained within a short period of time. Patients with reported high critical serum potassium values were characterized by high rates of comorbidity, reduced eGFR, and mortality. The incidence, clinical manifestations, and outcomes varied in the different clinical settings.
Publisher
Walter de Gruyter GmbH
Subject
Biochemistry, medical,Clinical Biochemistry,General Medicine
Reference22 articles.
1. Lundberg, GD. When to panic over abnormal values. Med Lab Obs 1972;4:47–54. 2. Abuelo, JG. Treatment of severe hyperkalemia: confronting 4 fallacies. Kidney Int Rep 2017;3:47–55. https://doi.org/10.1016/j.ekir.2017.10.001. 3. Montford, JR, Linas, S. How dangerous is hyperkalemia? J Am Soc Nephrol 2017;28:3155–65. https://doi.org/10.1681/asn.2016121344. 4. Bouadma, L, Mankikian, S, Darmon, M, Argaud, L, Vinclair, C, Siami, S, et al.. Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients. Crit Care 2019;23:415. https://doi.org/10.1186/s13054-019-2679-z. 5. Thongprayoon, C, Cheungpasitporn, W, Hansrivijit, P, Mao, MA, Medaura, J, Bathini, T, et al.. Admission serum potassium levels in hospitalized patients and one-year mortality. Medicines (Basel) 2019;7:2. https://doi.org/10.3390/medicines7010002.
|
|