Hypokalemia Following Trauma

Abstract

Frequent hypokalemia was noted immediately after trauma, and it was hypothesized that hypokalemia occurred more frequently in the more severely injured. A retrospective trauma registry and chart review was done on 546 trauma patients looking at admission potassium, a variety of lab tests related to potassium, specific injuries, hospital/ICU lengths of stay, and general patient demographics. Admission hypokalemia (K < 3.6 meq/l) was more frequent in those with closed head injuries (41.1% vs. 27.5%, P < .001) and in those who suffered spinal cord injuries (54.5% vs. 33.6%, P < .05). Hyperglycemia was more frequent with admission hypokalemia (45.2% vs. 29.7%, P < .001). Hypokalemia occurred more frequently in younger patients (28.6 vs. 37.7 y, P < .001). Also, the pediatric group, ages 5-14, had admission hypokalemia more frequently than those ages 15-59, or those ages > 59 (54.9% vs. 34.5% vs. 16.7%, P < .001). Glasgow Coma Scores (GCS) were significantly lower (12.0 vs. 13.5, P < .001) and Injury Severity Scores (ISS) were higher (17.4 vs. 13.4, P < .001), with admission hypokalemia. Additionally, hypokalemia was a positive predictor of ISS (P = .05). Hypokalemic patients more likely needed a ventilator, (26.6% vs. 16.5%, P < .01) but did not have significantly more ventilator days (P > .05). Subsequently, hypokalemic patients had longer ICU lengths of stay (LOS) (2.6 vs. 1.5 days, P < .005) and longer hospital LOS (8.5 vs. 5.6 days, P < .001). When stratified into categories of "severe": (K < 3.1 meq/l), "moderate": (K = 3.1-3.3 meq/l), and "mild": (K = 3.4-3.5 meq/l) hypokalemia, those with severe hypokalemia had significantly lower GCS (10.0 vs. 13.1, p < .05), higher serum glucose levels (167 vs. 137 mg/dl, P < .05), lower creatinine levels (.77 vs. .95 mg/dl, P < .05), and longer hospital lengths of stay (13.1 days vs. 7.6 days, P < .05 results).

Serum Sodium and Potassium Profile in Adult Head Injury Patients and Its Effect on Final Outcome

“…According to Beal AL et al, LOS in head injury with hypokalaemia was 8.5 days as compared to 5.6 days in other patients. 5 In this study, in hypokalaemic patients, LOS was 6.3 days as compared to 4.4 days in patients without electrolyte imbalance.…”

“…3,4 The incidence of hypokalaemia was 12.35% which was less as compared to study done by Beal AL et al (27.5%). 5 The incidence of hyperkalaemia was found to be 5% of 340 patients.…”

“…The result was at par with studies done by Nobuhiro Moro et al, Jawad Rochdi et al, Beal AL et al and Mirza Faisal Ahmed Rafiq et al respectively. 2,4,5,8 In a study by Sherlock M et al, it has been shown that hyponatraemia is common following SAH. 9 In the present study, association of SAH and hyponatraemia is evident as 10 out of 59 hyponatraemic patients (16.95%) as compared to the patients were without any electrolyte abnormalities where 16 cases out of 184 patients (8.7%) had SAH.…”

Dyskalaemia associated with thiopentone barbiturate coma for refractory intracranial hypertension: a case series

“…Hypokalaemia may occur in up to 41% of headinjured patients [7], and has been attributed to the sympathetic stress response and catecholamine surge [8][9][10].…”

“…Forty-two (89.4%) patients developed hypokalaemia after induction of barbiturate therapy. The median time to onset of hypokalaemia was 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) h and time to nadir of serum potassium levels was 25 h. Sixteen (34%) patients developed hyperkalaemia on weaning of barbiturate therapy. The peak serum potassium levels developed 31 (28-56) h after cessation.…”