Efficacy and Safety of Potassium Infusion Therapy in Hypokalemic Critically Ill Patients

Hamill, Robin J.; Robinson, Laura M.; Wexler, H. R.; Foote, Celine

doi:10.1097/00132586-199112000-00043

Cited by 5 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, clinicians intentionally administer less than the estimated potassium deficit for patient safety in an effort to avoid potential life‐threatening hyperkalemia. Since potassium rapidly redistributes within a couple hours following IV infusion, 10 , 12 serum potassium concentrations are reevaluated on a frequent basis with repeated potassium infusions given as necessary. This common practice explains our algorithmic dosing approach to improving serum potassium concentrations for each potassium depletion group with the short‐term goal of achieving a serum potassium concentration of ≥4.0 mEq/L, ≥3.5 mEq/L, and ≥3 mEq/L for each state of potassium depletion, respectively, with the ultimate goal in achieving a serum potassium concentration ≥4.0 mEq/L for all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Hypokalemia may have potential detrimental effects 1 , 8 and, if left untreated, can progress to severe depletion, resulting in cardiac arrhythmias, cardiac arrest, or respiratory arrest. Although other intravenous (IV) potassium dosing algorithms have been published, 10 – 16 none of these studies specifically address the critically ill patient who required specialized nutrition support or patients with traumatic injuries. Critically ill patients with traumatic injuries are unique in that they are consistently hypercatabolic 17 and have been shown to require aggressive dosing of other intracellular electrolytes 1 , 18– 23 .…”

Section: Introductionmentioning

confidence: 99%

“…Critically ill patients with traumatic injuries are unique in that they are consistently hypercatabolic 17 and have been shown to require aggressive dosing of other intracellular electrolytes 1 , 18– 23 . As a result of these findings with other intracellular electrolytes and based on our empiric experience with potassium dosing for our trauma patient population, we developed a potassium dosing algorithm that was generally more aggressive than doses recommended for other critically ill populations 10 – 16 . The purpose of this study was to evaluate the safety and efficacy of our Nutrition Support Service–guided IV potassium dosing algorithm for critically ill patients with traumatic injuries.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of an Intravenous Potassium Dosing Algorithm for Hypokalemic Critically Ill Patients

Johnston

Maish

Minard

et al. 2015

J Parenter Enteral Nutr

View full text Add to dashboard Cite

Purpose: The intent of this study was to evaluate the safety and efficacy of an intravenous (IV) potassium (K) dosing algorithm for hypokalemic critically ill trauma patients. Methods: Adult patients, admitted to the trauma intensive care unit from June 2010 to October 2012 and who received IV K therapy according to a standardized dosing algorithm, were retrospectively evaluated. Patients who received IV K during resuscitation or following initiation of nutrition therapy, IV fluids containing >20 mEq/L of potassium, or medications known to alter K homeostasis or those with an arterial pH change >0.1, diarrhea, hypomagnesemia, renal impairment, or morbid obesity were excluded. Results: In total, 715 patients were reviewed to obtain 100 evaluable patients. Serum K for patients with mild depletion (serum K, 3.5–3.9 mEq/L, n = 74) remained unchanged at 0.0 ± 0.3 mEq/L (P = ns) following 46 ± 8 mEq. Serum K increased by 0.4 ± 0.3 mEq/L (P = .001) following 78 ± 18 mEq during moderate depletion (serum K, 3–3.4 mEq/L). None of the patients experienced hyperkalemia (serum K, >5.2 mEq/L) postinfusion. The presence of traumatic brain injury (TBI) blunted the response to IV K for mild K depletion as only 26% had an increase in serum K compared with 55% of patients without TBI (P = .025). Conclusions: The Nutrition Support Service–guided IV K dosing algorithm was safe for patients with mild and moderate hypokalemia and efficacious for those with moderate hypokalemia. Further study in patients with severe hypokalemia (serum K, <3 mEq/L) is warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of an Intravenous Potassium Dosing Algorithm for Hypokalemic Critically Ill Patients

Johnston

Maish

Minard

et al. 2015

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…[45–47] Studies do support a benefit in maintaining certain threshold concentrations of potassium and magnesium. [48–50] However, evidence for a similar approach to address hypocalcemia is sparse. [5, 11] In a murine model of severe sepsis, we observed an apparent dose-response between a single pharmacological dose of calcium and an increased risk of organ dysfunction and death.…”

Section: Discussionmentioning

confidence: 99%

Calcium Supplementation During Sepsis Exacerbates Organ Failure and Mortality via Calcium/Calmodulin-Dependent Protein Kinase Kinase Signaling

Collage

Howell

Zhang

et al. 2013

Critical Care Medicine

View full text Add to dashboard Cite

Background Calcium plays an essential role in nearly all cellular processes. As such, cellular and systemic calcium concentrations are tightly regulated. During sepsis derangements in such tight regulation frequently occur, and treating hypocalcemia with parenteral calcium administration remains the current practice guideline. Objective We investigated whether calcium administration worsens mortality and organ dysfunction using an experimental murine model of sepsis and explored the mechanistic role of the family of calcium/calmodulin-dependent protein kinases in mediating these physiologic effects. To highlight the biological relevance of these observations, we conducted a translational study of the association between calcium administration, organ dysfunction and mortality among a cohort of critically ill septic ICU patients Design Prospective, randomized controlled experimental murine study. Observational clinical cohort analysis. Setting University research laboratory. Eight ICUs at a tertiary care center. Patients 870 septic ICU patients. Subjects C57BL/6 and CaMKK−/− mice. Interventions Mice underwent cecal ligation and puncture polymicrobial sepsis and were administered calcium chloride (0.25 or 0.25 mg/kg) or normal saline. Measurements and Main Results Administering calcium chloride to septic C57BL/6 mice heightened systemic inflammation and vascular leak, exacerbated hepatic and renal dysfunction, and increased mortality. These events were significantly attenuated in CaMKK−/− mice. In a risk–adjusted analysis of septic patients, calcium administration was associated with an increased risk of death, OR 1.92 (95% CI 1.00–3.68, p=0.049), a significant increase in the risk of renal dysfunction, OR 4.74 (95% CI 2.48–9.08, p<0.001), and a significant reduction in ventilator free days, mean decrease 3.29 days (0.50–6.08 days, p=0.02). Conclusions Derangements in calcium homeostasis occur during sepsis that are sensitive to calcium administration. This altered calcium signaling, transduced by the CaMKK cascade, mediates heightened inflammation and vascular leak that culminates in elevated organ dysfunction and mortality. In the clinical management of septic patients calcium supplementation provides no benefit and may impose harm.

show abstract

“…Amphotericin B may cause increased loss of potassium by binding to sterols in cell membranes and increasing permeability. 89 Careful mixing of potassium chloride after addition to flexible bags of fluids is extremely important to prevent the patient from receiving a high concentration of potassium that could be life threatening. 45 TREATMENT Preparations available for parenteral use include KCl (2 mEq K þ /mL) and a potassium phosphate solution containing K 2 HPO 4 and KH 2 PO 4 (4.36 mEq K þ /mL).…”

Section: Specific Causes Of Hypokalemia In Dogs and Catsmentioning

confidence: 99%

Disorders of Potassium

DiBartola¹,

Morais²

2012

Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

View full text Add to dashboard Cite

Efficacy and Safety of Potassium Infusion Therapy in Hypokalemic Critically Ill Patients

Cited by 5 publications

References 0 publications

Evaluation of an Intravenous Potassium Dosing Algorithm for Hypokalemic Critically Ill Patients

Evaluation of an Intravenous Potassium Dosing Algorithm for Hypokalemic Critically Ill Patients

Calcium Supplementation During Sepsis Exacerbates Organ Failure and Mortality via Calcium/Calmodulin-Dependent Protein Kinase Kinase Signaling

Disorders of Potassium

Contact Info

Product

Resources

About