Effectiveness and Safety of Potassium Replacement in Critically Ill Patients: A Retrospective Cohort Study

Abstract

Background Rules of thumb for potassium replacement are used in intensive care units despite minimal empirical validation. Objective To evaluate the effectiveness and safety of rule-of-thumb potassium replacement in critically ill patients with mild and moderate hypokalemia. Methods A retrospective, observational study was done of patients with mild (potassium, 3-3.9 mEq/L) and moderate (potassium, 2-2.9 mEq/L) hypokalemia admitted to a medical intensive care unit who received potassium replacement. Expected and actual frequencies of replacement that achieved target potassium concentrations (≥ 4 mEq/L) were compared by using a c 2 test. Logistic regression analysis was used to assess whether rule-of-thumb administration affected the probability of target attainment within 24 hours of replacement. Results Serum potassium concentrations were checked within 24 hours after potassium replacement on 354 of 577 days (61.4%) when replacement was provided. Concentrations were within target range in 82 instances (23.2%). Of 62 episodes of replacement expected to achieve the target according to the rule-ofthumb estimation, 22 did (35%). Rule-of-thumb administration was associated with greater likelihood of target attainment (odds ratio, 2.12; 95% CI, 1.18-3.85; P = .01). This difference in likelihood remained significant after adjustment for covariates (odds ratio, 2.18; 95% CI, 1.04-4.56; P = .04). Conclusion In critically ill patients given potassium replacement without regard to a formal protocol, the target serum potassium concentration was achieved more often than expected according to the rule-of-thumb estimation but less than one-third of the time. (Critical Care Nurse. 2019;39[1]:e13-e18)

Guiding Efficient, Effective, and Patient-Oriented Electrolyte Replacement in Critical Care: An Artificial Intelligence Reinforcement Learning Approach

“…However, the potential gains of thoughtful, well-planned implementation are considerable. Our estimation of the financial benefit is conservative and does not account for other factors that could not be quantified in the data [ 22 , 23 ].…”

“…Furthermore, the relationship between the target values of electrolyte levels and their clinical benefit is complex [ 21 ]. A provider-directed approach to electrolyte repletion can therefore often lead to unaddressed episodes of low electrolyte levels, high rates of superfluous replacements, and a poorly allocated use of provider time and expenditures, while creating risk to the patient [ 17 , 22 , 23 , 24 ].…”

DNA Aptamer Functionalized Hydrogels for Interferometric Fiber-Optic Based Continuous Monitoring of Potassium Ions

“…When severe, potassium disorders can lead to life-threatening cardiac rhythm disturbances and neuromuscular dysfunction which may provoke sudden cardiac arrest or respiratory failure. Critically ill patients with potassium disorders had a higher incidence of cardiac arrhythmia and intensive care unit (ICU) mortality than patients with normal potassium levels [2][3][4][5][6][7][8][9][10][11][12]. Therefore, an effective, rapid, and selective method for continuous point-of-care (POC) potassium monitoring is highly desirable, particularly in the ICU where timely therapy is of crucial importance.…”