Community-acquired hypokalemia in elderly patients: related factors and clinical outcomes

Bardak, Simge; Turgutalp, Kenan; Koyuncu, Mahmut Bakır; Hendarto, Hari; Helvacı, İlter; Ovla, Didem; Horoz, Mehmet; Demir, Serap; Kıykım, Ahmet

doi:10.1007/s11255-016-1489-3

Cited by 13 publications

(7 citation statements)

References 18 publications

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“…21 Moreover, hypokalaemia is associated with increased all-cause mortality in the elderly and in patients with chronic kidney disease (CKD). 22 23 We also observed trends for increased rates of hypernatremia and acute kidney injury, both of which are more traditionally associated with poor clinical outcomes in patients with cirrhosis. 24 25 There are multiple possible explanations for these findings, but we posit that patients treated with the order set were treated more aggressively with lactulose.…”

Section: Discussionmentioning

confidence: 75%

Unexpected clinical outcomes following the implementation of a standardised order set for hepatic encephalopathy

Olson

Wang

et al. 2021

BMJ Open Gastroenterol

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ObjectiveWe evaluated the effect on clinical outcomes of implementing a standardised inpatient order set for patients admitted with hepatic encephalopathy (HE).MethodsA retrospective review of patients with cirrhosis admitted with HE. Hospital admissions for HE for which the electronic health record (EHR) order set was used were compared with admissions where the order set was not used. Primary outcome was length of hospital stay (LOS). Secondary outcomes were 30-day readmissions, in-hospital complications, in-hospital and 90-day mortality.ResultsThere were 341 patients with 980 admissions over the study period: 263 patients with 736 admissions where the order set was implemented, and 78 patients with 244 admissions where the order set was not implemented. Median LOS was 4 days (IQR 3–8) in the order set group compared with 3 days (IQR 2–7) (p<0.001); incidence rate ratio 1.37 (95% CI 1.20 to 1.57), p<0.001. 30-day readmissions rate was 56% in the order set group compared with 40%, p=0.01; OR for readmission was 1.88 (95% CI 1.04 to 3.43), p=0.04. Hypokalaemia occurred in 46% of admissions with order set use compared with 36%, when the order set was not used; p=0.003, OR 1.72 (95% CI 1.22 to 2.43), p=0.002. No significant differences were seen for in-hospital mortality and 90-day mortality.ConclusionImplementation of an inpatient EHR order set for use in patients with HE was associated with unexpected clinical outcomes including increased LOS and readmissions. The convenience and advantages of standardisation of patient care should be balanced with a degree of individualisation, particularly in the care of medically complex patients. Furthermore, standardised processes should be evaluated frequently after implementation to assess for unintended consequences.

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Section: Discussionmentioning

confidence: 75%

Unexpected clinical outcomes following the implementation of a standardised order set for hepatic encephalopathy

Olson

Wang

et al. 2021

BMJ Open Gastroenterol

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“…Our study showed that pre-existing hypokalemia at admission is one of the risk factors of preoperative hypokalemia. Bardak et al reported that the incidence of community-acquired hypokalemia in elderly patients was 3.24%, and LOS, hospital cost, and all-cause mortality in hypokalemia group were higher [ 11 ]. Of note, a total of 7.09% of all patients in our study had hypokalemia at admission, more than twice the rate reported by Bardak et al The discrepancy may be attributed to dietary structure and metabolic characteristics [ 30 ] of different ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

“…With a further decrease in blood potassium concentration, moderate and severe hypokalemia may cause serious complications such as muscle weakness, paralytic ileus, metabolic acidosis, urinary retention, rhabdomyolysis, arrhythmia, and even death [ 1 , 4 , 9 , 10 ]. In patients with comorbidities, hypokalemia usually portends a worse prognosis [ 11 ]. Studies have shown that the prevalence of perioperative hypokalemia was 14 to 40% in general hospital population [ 1 , 4 , 12 , 13 ], but evidence on the morbidity and risk factors of preoperative hypokalemia in elderly patients is lacking.…”

Section: Introductionmentioning

confidence: 99%

“…In developing countries, people over 60 years old are classified as the elderly, who have age-related declines in physiology [ 14 , 15 ]. Due to reduced skeletal muscle mass and increased comorbidities [ 11 , 16 ], elderly people are more likely to develop hypokalemia and have worse tolerance than young people [ 4 , 17 , 18 ]. A study has shown that perioperative hypokalemia increases the risk of delayed recovery of gastrointestinal function, acute kidney injury, and adverse cardiovascular events [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between preoperative hypokalemia and postoperative complications in elderly patients: a retrospective study

Chu

2022

BMC Geriatr

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Background Hypokalemia is a common form of electrolyte disorder, which has a higher incidence in hospitalized patients and is closely related to perioperative complications and prognosis. Due to decreased skeletal muscle mass which causes total body potassium reduction, and increased comorbidities, the elderly are more susceptible to hypokalemia. Objective To investigate preoperative hypokalemia in elderly patients and its effect on postoperative complications. Methods Data were retrospectively collected from the elderly patients who underwent elective surgery from April 2018 to March 2019 and had preoperative blood gas data available. Patients, with age 60 to 100 years, were divided into hypokalemia group (potassium level < 3.5 mmol/L) and normokalemia group (potassium level between 3.5 and 5.5 mmol/L) according to preoperative blood gas analysis. Hypokalemia can be divided into mild (potassium level 3.0 to 3.5 mmol/L), moderate (potassium level 2.5 to 3.0 mmol/L) and severe (potassium level < 2.5 mmol/L), respectively. The risk factors of preoperative hypokalemia and its impact on postoperative complications and prognosis were primary outcomes. Secondary outcomes included postanesthesia care unit (PACU) stay time and hospital length of stay (LOS). Results Of 987 participants, 436 (44.17%) developed preoperative hypokalemia, among them 357 (81.88%) mild, 87 (16.74%) moderate and 6 (1.38%) severe. Multivariate logistic regression showed that female gender (OR, 1.851; 95% CI, 1.415–2.421), pre-existing hypokalemia at admission (OR, 4.498; 95% CI, 2.506–8.071), and oral laxative twice or more (OR, 1.823; 95% CI, 1.266–2.624) are risk factors of preoperative hypokalemia. Gynecological and biliopancreatic surgery were more common in hypokalemia group than normokalemia group (P < 0.001, P < 0.05). There was no significant difference in postoperative complications, PACU stay time, LOS, and 30-day mortality between the two groups (all P > 0.05). Conclusions Female gender, pre-existing hypokalemia at admission, and oral laxative twice or more are independent risk factors for preoperative hypokalemia in elderly patients. However, postoperative complications and 30-day mortality were not increased, which may be related to monitoring blood gas analysis and prompt correction of potassium levels during surgery.

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“…The prevalence of hypokalemia case inpatient elderly (above 65 y old) was found 3.24%. The incidence of hypokalemia increases according to age increase, the number of comorbidities, or use of other agents that may cause to increased risk of hypokalemia, especially in the elderly [5,12]. A patient with polymyositis was treated with 0.5 g/day methylprednisolone for a 3-day course, and the patient has hypokalemia.…”

Section: Discussionmentioning

confidence: 99%

Methylprednisolone Induced Hypokalemia in an Idiopathic Thrombocytopenic Purpura (Itp) Patient

Arrang

Cokro

2020

Int J Pharm Pharm Sci

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We reported an Idiopathic Thrombocytopenic Purpura (ITP) patient, 66-years-old (woman), with hypokalemia. She received 125 mg three times daily of methylprednisolone injection for her ITP. Corticosteroids are the initial treatment of ITP. Her potassium level decrease after she took methylprednisolone. Hypokalemia is also a common problem affecting the elderly or geriatric population. Many literatures reported side effects of corticosteroid is associated with hypokalemia. Monitoring potassium levels must be check during corticosteroid therapy. In this report, we describe the association between corticosteroid with hypokalemia effect.

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Community-acquired hypokalemia in elderly patients: related factors and clinical outcomes

Abstract: Length of hospital stay, hospital cost, and MR were higher in elderly with CAH. Female gender, hydrochlorothiazides, loop diuretics, and ≥2 comorbid diseases are the leading risk factors associated with CAH in elderly.

Cited by 13 publications

References 18 publications

Unexpected clinical outcomes following the implementation of a standardised order set for hepatic encephalopathy

Unexpected clinical outcomes following the implementation of a standardised order set for hepatic encephalopathy

Association between preoperative hypokalemia and postoperative complications in elderly patients: a retrospective study

Methylprednisolone Induced Hypokalemia in an Idiopathic Thrombocytopenic Purpura (Itp) Patient

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