Hyperkalemia in the emergency department: Etiology, symptoms and outcome of a life threatening electrolyte disorder

Pfortmüller, Carmen Andrea; Leichtle, Alexander Benedikt; Fiedler, Georg Martin; Exadaktylos, Aristomenis K.; Lindner, Gregor

doi:10.1016/j.ejim.2013.02.010

Cited by 30 publications

(28 citation statements)

References 7 publications

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“…In the United States the prevalence of potassium >5.0 mmol/l was 3.6%, 112 whereas in Switzerland the prevalence of potassium >4.5 mmol/l, the upper limit of normal, was 8.8%. 167 Risk factors. Factors associated with an increased likelihood of the development of hyperkalemia are summarized in Supplementary Table S7.…”

Section: Acute Hyperkalemiamentioning

confidence: 99%

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Clase

Carrero

Ellison

et al. 2020

Kidney International

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Section: Acute Hyperkalemiamentioning

confidence: 99%

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Clase

Carrero

Ellison

et al. 2020

Kidney International

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325

303

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“…Hyperkalemia is a common condition that accounts for 1% to 10% of admissions to emergency departments, with fatal complications if severe and left untreated. 1 , 2 Hyperkalemia accounts for 3.1% of all ESRD-related deaths 3 and is associated with a high risk of death in acute medical admissions to the hospital. 4 , 5 , 6 Management of hyperkalemia involves reversing membrane polarization abnormalities, 7 shifting potassium from the extracellular to the intracellular space, and removing potassium from the extracellular compartment.…”

mentioning

confidence: 99%

Treatment of Hyperkalemia With a Low-Dose Insulin Protocol Is Effective and Results in Reduced Hypoglycemia

McNicholas

Pham

Carli

et al. 2018

Kidney International Reports

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IntroductionComplications associated with insulin treatment for hyperkalemia are serious and common. We hypothesize that, in chronic kidney disease (CKD) and end-stage renal disease (ESRD), giving 5 units instead of 10 units of i.v. regular insulin may reduce the risk of causing hypoglycemia when treating hyperkalemia.MethodsA retrospective quality improvement study on hyperkalemia management (K+ ≥ 6 mEq/l) from June 2013 through December 2013 was conducted at an urban emergency department center. Electronic medical records were reviewed, and data were extracted on presentation, management of hyperkalemia, incidence and timing of hypoglycemia, and whether treatment was ordered as a protocol through computerized physician order entry (CPOE). We evaluated whether an educational effort to encourage the use of a protocol through CPOE that suggests the use of 5 units might be beneficial for CKD/ESRD patients. A second audit of hyperkalemia management from July 2015 through January 2016 was conducted to assess the effects of intervention on hypoglycemia incidence.ResultsTreatments ordered using a protocol for hyperkalemia increased following the educational intervention (58 of 78 patients [74%] vs. 62 of 99 patients [62%]), and the number of CKD/ESRD patients prescribed 5 units of insulin as per protocol increased (30 of 32 patients [93%] vs. 32 of 43 [75%], P = .03). Associated with this, the incidence of hypoglycemia associated with insulin treatment was lower (7 of 63 patients [11%] vs. 22 of 76 patients [28%], P = .03), and there were no cases of severe hypoglycemia compared to the 3 cases before the intervention.ConclusionEducation on the use of a protocol for hyperkalemia resulted in a reduction in the number of patients with severe hypoglycemia associated with insulin treatment.

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“…Disorders of serum sodium and potassium are common in outpatients and were found to be present in more than 10% of patients, respectively [1,2,3]. Many factors have been found to be associated with the development of dysnatremias and dyskalemias, with diuretic therapy being the most prominent [4,5].…”

Section: Introductionmentioning

confidence: 99%

Age-Related Variety in Electrolyte Levels and Prevalence of Dysnatremias and Dyskalemias in Patients Presenting to the Emergency Department

Lindner¹,

Pfortmüller²,

Leichtle

et al. 2014

Gerontology

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Background: It was found that age and female gender are predisposing factors for hyponatremia in patients taking thiazides. Objective: To investigate whether a relationship exists between age and gender and serum sodium and potassium as well as the prevalence rates in a large population of patients presenting to the emergency department of a university hospital. Methods: In this retrospective analysis we gathered data on age, gender and current diuretic medication of all patients admitted to the emergency department of a large university hospital with measurement of serum sodium and potassium between January 1, 2009 and December 31, 2010. Prevalence rates of and risk factors for electrolyte disorders were calculated on the basis of these data. Results: A total of 20,667 patients were included in the analysis. Serum sodium levels declined significantly with increasing age while serum potassium rose, independent of diuretic medication at presentation. The prevalence rates of hyponatremia and hyperkalemia increased from 2.3% for hyponatremia in patients aged 16-21 years to 16.9% in patients aged >80 years and from 0.8% for hyperkalemia to 10.4%. In the regression analysis, age >60 years was a predictor for the presence of hyponatremia and hyperkalemia as was current use of diuretic medication. Male gender was associated with a decreased prevalence of hyponatremia and hypokalemia, while it was a predictor of hyperkalemia. Conclusions: Sodium levels were lower with increasing age, independent of diuretic intake, while potassium levels were higher. We found dramatically increasing prevalences of hyponatremia and hyperkalemia with increasing age, while no such effect could be found for hypernatremia and hypokalemia.

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Hyperkalemia in the emergency department: Etiology, symptoms and outcome of a life threatening electrolyte disorder

Cited by 30 publications

References 7 publications

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Treatment of Hyperkalemia With a Low-Dose Insulin Protocol Is Effective and Results in Reduced Hypoglycemia

Age-Related Variety in Electrolyte Levels and Prevalence of Dysnatremias and Dyskalemias in Patients Presenting to the Emergency Department

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