Efficacy and safety of potassium infusion therapy in hypokalemic critically ill patients

Hamill, Robin J.; Robinson, Lynda; Wexler, H. R.; Moote, Carol A.

doi:10.1097/00003246-199105000-00016

Cited by 58 publications

(33 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…potassium dose of 20-40 meq for an ICU patient with mild to moderate hypokalemia (serum potassium concentration = 2.5-3.4 meq/L) ( Table 2). [105][106][107] Patients with symptomatic or severe hypokalemia (serum potassium concentration of <2.5 meq/L) require more aggressive therapy with initial i.v. potassium doses of up to 40-80 meq.…”

Section: Potassiummentioning

confidence: 99%

See 1 more Smart Citation

Treatment of electrolyte disorders in adult patients in the intensive care unit

Kraft

Btaiche²,

Sacks³

et al. 2005

American Journal of Health-System Pharmacy

237

202

View full text Add to dashboard Cite

Purpose. The treatment of electrolyte disorders in adult patients in the intensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. Summary. Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number of prospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic, isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for determining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient's response to the initial treatment. Actual electrolyte correction requires individual adjustment based on the patient's clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. Conclusion. Treatment of electrolyte disorders is often empirical, based on published literature, expert opinion and recommendations, and patient's response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients.

show abstract

Section: Potassiummentioning

confidence: 99%

“…In critical situations, infusion rates as high as 40 meq/hr have been used but should be reserved for emergent cases or symptomatic patients. 107 Total daily potassium supplementation should not exceed 240-400 meq/day. Potassium concentration in solutions for continuous infusion via a peripheral vein should be limited to 80 meq/L.…”

Section: Potassiummentioning

confidence: 99%

Treatment of electrolyte disorders in adult patients in the intensive care unit

Kraft

Btaiche²,

Sacks³

et al. 2005

American Journal of Health-System Pharmacy

237

202

View full text Add to dashboard Cite

show abstract

“…Therefore, derangements of blood potassium levels should be avoided in critically ill patients or, when present, rapidly corrected [3-5]. In the intensive care unit (ICU) potassium is administrated continuously by syringe pump, either enterally or parenterally [6-9]. Keeping potassium levels within the normal range (3.5-5.0 mmol/L) requires frequent blood potassium measurements and subsequent adjustments of potassium intake.…”

Section: Introductionmentioning

confidence: 99%

Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit - a before and after analysis

Hoekstra

Vogelzang

Drost

et al. 2010

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

BackgroundPotassium disorders can cause major complications and must be avoided in critically ill patients. Regulation of potassium in the intensive care unit (ICU) requires potassium administration with frequent blood potassium measurements and subsequent adjustments of the amount of potassium administrated. The use of a potassium replacement protocol can improve potassium regulation. For safety and efficiency, computerized protocols appear to be superior over paper protocols. The aim of this study was to evaluate if a computerized potassium regulation protocol in the ICU improved potassium regulation.MethodsIn our surgical ICU (12 beds) and cardiothoracic ICU (14 beds) at a tertiary academic center, we implemented a nurse-centered computerized potassium protocol integrated with the pre-existent glucose control program called GRIP (Glucose Regulation in Intensive Care patients). Before implementation of the computerized protocol, potassium replacement was physician-driven. Potassium was delivered continuously either by central venous catheter or by gastric, duodenal or jejunal tube. After every potassium measurement, nurses received a recommendation for the potassium administration rate and the time to the next measurement. In this before-after study we evaluated potassium regulation with GRIP. The attitude of the nursing staff towards potassium regulation with computer support was measured with questionnaires.ResultsThe patient cohort consisted of 775 patients before and 1435 after the implementation of computerized potassium control. The number of patients with hypokalemia (<3.5 mmol/L) and hyperkalemia (>5.0 mmol/L) were recorded, as well as the time course of potassium levels after ICU admission. The incidence of hypokalemia and hyperkalemia was calculated. Median potassium-levels were similar in both study periods, but the level of potassium control improved: the incidence of hypokalemia decreased from 2.4% to 1.7% (P < 0.001) and hyperkalemia from 7.4% to 4.8% (P < 0.001). Nurses indicated that they considered computerized potassium control an improvement over previous practice.ConclusionsComputerized potassium control, integrated with the nurse-centered GRIP program for glucose regulation, is effective and reduces the prevalence of hypo- and hyperkalemia in the ICU compared with physician-driven potassium regulation.

show abstract

“…To minimize dosing errors it is administered in a "one-to-one" 1 mmol/ml solution. Potassium chloride suppletion in critically ill patients is efficient and safe in a dose-dependent and predictable way (independent of the use of diuretics or the kidney function) [15,16,36]. The maximum administration rate advised by GRIP-II is 20 mmol/hour.…”

Section: Methodsmentioning

confidence: 99%

Trial design: Computer guided normal-low versus normal-high potassium control in critically ill patients: Rationale of the GRIP-COMPASS study

et al. 2010

View full text Add to dashboard Cite

BackgroundPotassium depletion is common in hospitalized patients and can cause serious complications such as cardiac arrhythmias. In the intensive care unit (ICU) the majority of patients require potassium suppletion. However, there are no data regarding the optimal control target in critically ill patients. After open-heart surgery, patients have a strongly increased risk of atrial fibrillation or atrial flutter (AFF). In a novel trial design, we examined if in these patients different potassium control-targets within the normal range may have different effects on the incidence of AFF.Methods/DesignThe "computer-driven Glucose and potassium Regulation program in Intensive care Patients with COMparison of PotASSium targets within normokalemic range (GRIP-COMPASS) trial" is a single-center prospective trial in which a total of 1200 patients are assigned to either a potassium control-target of 4.0 mmol/L or 4.5 mmol/L in consecutive alternating blocks of 50 patients each. Potassium levels are regulated by the computer-assisted potassium suppletion algorithm called GRIP-II (Glucose and potassium regulation for Intensive care Patients). Primary endpoint is the in-hospital incidence of AFF after cardiac surgery. Secondary endpoints are: in-hospital AFF in medical patients or patients after non-cardiac surgery, actually achieved potassium levels and their variation, electrolyte and glucose levels, potassium and insulin requirements, cumulative fluid balance, (ICU) length of stay, ICU mortality, hospital mortality and 90-day mortality.DiscussionThe GRIP-COMPASS trial is the first controlled clinical trial to date that compares potassium targets. Other novel methodological elements of the study are that it is performed in ICU patients where both targets are within the normal range and that a computer-assisted potassium suppletion algorithm is used.Trial registrationNCT 01085071 at ClinicalTrials.gov

show abstract

Efficacy and safety of potassium infusion therapy in hypokalemic critically ill patients

Cited by 58 publications

References 0 publications

Treatment of electrolyte disorders in adult patients in the intensive care unit

Treatment of electrolyte disorders in adult patients in the intensive care unit

Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit - a before and after analysis

Trial design: Computer guided normal-low versus normal-high potassium control in critically ill patients: Rationale of the GRIP-COMPASS study

Contact Info

Product

Resources

About