Hypokalemia: a clinical update

Kardalas, Efstratios; Paschou, Stavroula Α.; Anagnostis, Panagiotis; Muscogiuri, Giovanna; Siasos, Gerasimos; Vryonidou, Andromachi

doi:10.1530/ec-18-0109

Cited by 207 publications

(201 citation statements)

References 49 publications

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“…Hypokalemia is a potential etiology of QTc prolongation and torsades de pointes. However, the serum potassium level has to be significantly low (less than 3 mmol/L) in order to cause clinically significant ventricular arrhythmias [12]. This patient was taking escitalopram as a prescription medication for her psychiatric symptoms.…”

Section: Discussionmentioning

confidence: 99%

Anti-N-methyl-D-aspartate Receptor Encephalitis Associated with Ictal Torsades de Pointes and Cardiac Arrest

Inayat

Pinto

Ahmad

et al. 2019

Cureus

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Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is a rare clinical entity that typically presents with psychiatric disturbances and neurological deficits. It is commonly associated with ovarian teratomas. Although these patients demonstrate a predilection to develop cardiac arrhythmias, such complications are frequently self-limited. We chronicle here a unique case of a young woman with adnexal teratoma who experienced a tonic-clonic seizure and cardiac arrest. Electrocardiogram showed polymorphic ventricular tachycardia, consistent with torsade de pointes. Based on extensive diagnostic workup and exclusion of probable etiologies, she was diagnosed with anti-NMDA receptor encephalitis. To the best of our knowledge, this report represents the first case of anti-NMDA receptor encephalitis complicated by ictal torsades de pointes, leading to cardiac arrest. This paper illustrates that patients with anti-NMDA receptor encephalitis can develop life-threatening cardiac dysrhythmia and cardiac arrest, requiring urgent management. Clinicians should be vigilant for severe autonomic dysfunction as prompt etiology establishment is of paramount importance in these patients.

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Section: Discussionmentioning

confidence: 99%

Anti-N-methyl-D-aspartate Receptor Encephalitis Associated with Ictal Torsades de Pointes and Cardiac Arrest

Inayat

Pinto

Ahmad

et al. 2019

Cureus

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“…Hypokalaemia is one of the most frequently occurring electrolyte disturbances in hospitalized patients, with a reported prevalence as high as 20% . In contrast to milder hypokalaemias (3.4‐2.9 mmol/L) which do not always require immediate treatment, hypokalaemias below 2.9 mmol/L are independently associated with an increased mortality, requiring immediate action, especially in patients with pre‐existing cardiac disease . Initial corrective action is simple, consisting of potassium supplementation.…”

Section: Background and Significancementioning

confidence: 99%

Clinical rule‐guided pharmacists' intervention in hospitalized patients with hypokalaemia: A time series analysis

et al. 2019

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What is known and objective: Physicians' response to moderate and severe hypokalaemia in hospitalized patients is frequently suboptimal, leading to increased risk of cardiac arrhythmias and sudden death. While actively alerting physicians on all critical care values using telephone or electronic pop-ups can improve response, it can also lead to alert fatigue and frustration due to non-specific and overdue alerts.Therefore, a new method was tested. A clinical rule built into a clinical decision support system (CDSS) generated alerts for patients with a serum potassium level (SPL) <2.9 mmol/L without a prescription for potassium supplementation. If the alert was deemed clinically relevant, a pharmacist contacted the physician. The aim of this study was to evaluate the impact of the clinical rule-guided pharmacists' intervention compared to showing passive alerts in the electronic health records on outcome in patients who developed hypokalaemia (<2.9 mmol/L) during hospitalization. Methods:A before (2007)(2008)(2009)) and after (2010-2017) study with time series design was performed. Pre-intervention, physicians were shown passive alerts for hypokalaemia in the electronic health records. During the intervention period, in addition to these passive alerts, a pharmacist provided the physician with a specific advice on patients with untreated hypokalaemia, guided by the generated alerts. Unique patients >18 years with SPL <2.9 mmol/L measured at least 24 hours after hospitalization in whom no potassium supplementation was initiated within 4 hours after measurement and normalization of SPL was not achieved within these 4 hours were included. Haemodialysis patients were excluded. The percentage of hypokalaemic patients with a subsequent prescription for potassium supplementation, time to subsequent potassium supplementation prescription, the percentage of patients who achieved normokalaemia (SPL ≥ 3.0 mmol/L), time to achieve normokalaemia and total duration of hospitalization were compared. Results and discussion: A total of 693 patients were included, of whom 278 participated in the intervention phase. The percentage of patients prescribed supplementation as well as time to prescription improved from 76.0% in 31.1 hours to 92.0% in 11.3 hours (P < .01). Time to achieve SPL ≥3.0 mmol/L improved, P < .009. No changes, however, were observed in the percentage of patients who achieved normokalaemia or time to reach normokalaemia, 87.5% in 65.2 hours pre-intervention compared to 90.2% (P = .69) in 64.0 hours (P = .71) in the intervention group. A non-significant | 521 WASYLEWICZ Et AL. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Wasylewicz ATM, Korsten EHM, Egberts TCG, Grouls RJE. Clinical rule-guided pharmacists' intervention in hospitalized patients with hypokalaemia: A time series analysis. J Clin Pharm Ther. 2020;45:520-529.

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“…8,11 Nilai kalium normal ibu hamil adalah 3,3-5,1 mEq/L, sedangkan pada pasien ini nilainya sangat rendah (1,9 mEq/L) sehingga terjadi kelemahan otot akibat hiperpolarisasi membran sel. 12,13 Koreksi kadar kalium didalam serum akan memperbaiki kelemahan otot. 8,9 Oleh karena itu, pasien diberikan terapi KCl untuk mengembalikan kadar normal kalium serum.…”

Section: Diskusiunclassified

“…Mencari penyebab hipokalemia penting dilakukan sebagai upaya mencegah kelemahan berulang kembali. 12,13 Pemeriksaan kalium urin 24 jam pasien dengan hasil 15 mmol/24 jam menunjukkan hipokalemia tidak disebabkan oleh renal loss. Penyebab hipokalemia karena gastrointestinal loss juga dapat disingkirkan karena dari anamnesis tidak ada riwayat atau keluhan gangguan saluran cerna seperti muntah dan diare.…”

Section: Diskusiunclassified

“…Perpindahan intraseluler kalium seperti pemakaian insulin, stimulasi sistem saraf simpatis (albuterol, terbutalin), tirotoksikosis, dan paralisis periodik familial juga dapat mengakibatkan hipokalemia. 12,13 Pemeriksaan hormon tiroid dalam batas normal dan pasien tidak menggunakan obat insulin ataupun obat asma. Oleh karena itu, hipokalemia pada pasien adalah suatu HPP primer (idiopatik atau familial).…”

Section: Diskusiunclassified

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Tata laksana Pasien Gravida 29–30 Minggu dengan Gagal Napas ec. Hypokalemic Periodic Paralysis yang Diperberat dengan Community Acquired Pneumonia

Gunadi

Suwarman²,

S³

2019

jap

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Penatalaksanaan sakit kritis pada wanita hamil memiliki karakteristik yang unik karena perubahan fisiologi selama kehamilan dan janin yang berkembang dalam uterus yang mendapat implikasi yang signifikan. Pada kasus ini, seorang perempuan 27 tahun yang sedang hamil gemeli usia kehamilan 29–30 minggu datang ke Instalasi Gawat Darurat (IGD) Rumah Sakit Dr. Hasan Sadikin Bandung dengan keluhan utama kelemahan keempat anggota gerak. Hasil pemeriksaan laboratorium didapatkan kadar kalium sangat rendah dan didiagnosis dengan hypokalemic periodic paralysis. Pasien mengalami gagal napas sehingga dilakukan intubasi dan diberikan bantuan ventilasi mekanik, kemudian dirawat di Intensive Care Unit (ICU). Gagal napas disertai penyulit community acquired pneumonia. Tata laksana ventilasi mekanik pada wanita hamil di ICU bersifat suportif dengan teknik sama seperti pada pasien tidak hamil, namun memiliki target khusus yang berbeda. Monitoring fetal heart rate (FHR) dapat mencerminkan kesejahteraan janin dan kondisi ibu. Tujuan penulisan laporan kasus ini adalah mengetahui pentingnya target pemberian ventilasi mekanik dan melakukan monitoring FHR pada pasien hamil di ICU. Management of Respiratory Failure Due to Hypokalemic Periodic Paralysis Complicated with Community Acquired Pneumonia in 29–30 Weeks of GestationManagement of critically ill pregnant women in Intensive Care Unit (ICU) has unique characteristics due to the physiological changes during pregnancy and the presence of growing fetus in the uterine which may present significant implications. This study presented a case of a 27 years old woman with 29–30 weeks of gestation of twin pregnancy who came to Emergency Room (ER) with the chief complaint of weakness in both lower and upper extremities. Laboratory investigations showed a very low potassium level and the patient was diagnosed with hypokalemic periodic paralysis. Patient then experienced respiratory failure at the ER, intubated, and mechanically ventilated and was sent to the ICU. Community-acquired pneumonia was complicating the respiratory failure. Basically, mechanical ventilation management for pregnant patient in ICU is supportive in nature and uses the same techniques employed for the non-pregnant patient. However, the goals are different as it is important to monitor fetal heart rate (FHR) in pregnant woman as this does not only reflect the fetal well-being but also the maternal condition. This case report is intended to show the importance of mechanical ventilation goal and FHR monitoring in pregnant patients in ICU.

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Hypokalemia: a clinical update

Cited by 207 publications

References 49 publications

Anti-N-methyl-D-aspartate Receptor Encephalitis Associated with Ictal Torsades de Pointes and Cardiac Arrest

Anti-N-methyl-D-aspartate Receptor Encephalitis Associated with Ictal Torsades de Pointes and Cardiac Arrest

Clinical rule‐guided pharmacists' intervention in hospitalized patients with hypokalaemia: A time series analysis

Tata laksana Pasien Gravida 29–30 Minggu dengan Gagal Napas ec. Hypokalemic Periodic Paralysis yang Diperberat dengan Community Acquired Pneumonia

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