Management of Severe Hypokalemia in Hospitalized Patients

Paltiel, Ora; Салахов, Э. М.; Ronen, Ilana; Berg, David D.; Israeli, Avi

doi:10.1001/archinte.161.8.1089

Cited by 65 publications

(22 citation statements)

References 19 publications

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“…12 Other studies have also shown that mortality is more in hypokalaemic subjects. 13,14 Hyperkalaemia was present in 14% cases in our study. Renal impairment, ACE inhibitors, ARBs and spironolactone were the precipitating factors.…”

Section: Discussionsupporting

confidence: 49%

Pattern of Electrolyte Imbalance in Hospitalized Diabetic Patients: Experience in a Tertiary Care Hospital

et al. 2012

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Pattern of Electrolyte Imbalance in Hospitalized DiabeticPatients 22% were on oral anti-diabetic agents and 6% were on medical nutrition therapy. Among the co-morbidities, hypertention was the most prevalent (61%), followed by ischaemic heart disease (24%), chronic kidney disease (21%), dyslipidaemia (8%) and fatty liver (4%). Diabetic peripheral neuropathy was present in 41% cases, nephropathy in 13% cases and retinopathy in 12% cases. Over all 78% (100 patients had electrolyte imbalance out of 128 patients) of patients had some sort of electrolyte imbalance, irrespective of cause of admission. Hyponatraemia was the most common electrolyte imbalance in this study (80%), followed by hypomagnaesemia (38%), hypokalaemia (36%) and hyperkalaemia (14%). In 11% cases there were hyponatraemia, hypokalaemia and hypomagnaesemia. Regarding the precipitating factors, vomiting was most common (51%). In 28% cases electrolyte imbalance was precipitated by various drugs. Diarrhea and renal failure were responsible in a minority of cases. In 4% cases no cause could be identified. No death occurred.Conclusion: From this cross-sectional study it can be concluded that, electrolyte imbalance is common in hospitalized diabetic patients. Serum electrolytes should be checked routinely in hospitalized diabetic patients irrespective of their purpose of admission.

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Section: Discussionsupporting

confidence: 49%

Pattern of Electrolyte Imbalance in Hospitalized Diabetic Patients: Experience in a Tertiary Care Hospital

et al. 2012

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“…About 40% of the patients on thiazide diuretics have been reported to suffer from hypokalemia (Gennari, 1998) and a tenfold increase in hospital mortality was found in hypokalemic patients (Paltiel et al, 2001). Potassium electrolyte disturbance in serum is recognized as a risk factor among LQTS patients.…”

Section: Introductionmentioning

confidence: 99%

“…Potassium electrolyte disturbance in serum is recognized as a risk factor among LQTS patients. The mortality rate of hospitalized hypokalemic patients was tenfold higher than in generalized hospital population illustrating the potentially life-threatening consequences of hypokalemia (Paltiel et al, 2001). Other studies on hypokalemia have reported prolonged QT-intervals, torsades de pointes and ventricular arrhythmias in LQT1 patients (Schulman and Narins, 1990; Roden, 1997).…”

Section: Introductionmentioning

confidence: 99%

Low extracellular potassium prolongs repolarization and evokes early afterdepolarization in human induced pluripotent stem cell-derived cardiomyocytes

et al. 2017

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Long QT syndrome (LQTS) is characterized by a prolonged QT-interval on electrocardiogram and by increased risk of sudden death. One of the most common and potentially life-threatening electrolyte disturbances is hypokalemia, characterized by low concentrations of K+. Using a multielectrode array platform and current clamp technique, we investigated the effect of low extracellular K+ concentration ([K+]Ex) on the electrophysiological properties of hiPSC-derived cardiomyocytes (CMs) generated from a healthy control subject (WT) and from two symptomatic patients with type 1 of LQTS carrying G589D (LQT1A) or IVS7-2A>G mutation (LQT1B) in KCNQ1. The baseline prolongations of field potential durations (FPDs) and action potential durations (APDs) were longer in LQT1-CMs than in WT-CMs. Exposure to low [K+]Ex prolonged FPDs and APDs in a concentration-dependent fashion. LQT1-CMs were found to be more sensitive to low [K+]Ex compared to WT-CMs. At baseline, LQT1A-CMs had more prolonged APDs than LQT1B-CMs, but low [K+]Ex caused more pronounced APD prolongation in LQT1B-CMs. Early afterdepolarizations in the action potentials were observed in a subset of LQT1A-CMs with further prolonged baseline APDs and triangular phase 2 profiles. This work demonstrates that the hiPSC-derived CMs are sensitive to low [K+]Ex and provide a platform to study acquired LQTS.

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“…Potassium disorders occur frequently in hospitalized patients [1,2] and it has long been known that extreme potassium values can cause life-threatening complications, especially in critically ill patients [3,4]. However, the effects on outcome of less pronounced differences in the potassium concentration, that occur much more frequently, are not known.…”

Section: Introductionmentioning

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

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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

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Management of Severe Hypokalemia in Hospitalized Patients

Abstract: The computerized laboratory database is useful in ascertaining the prevalence of severe hypokalemia and in assessing shortcomings in its management. Databases can be used to derive valid and efficient measures of the quality of the clinical management of electrolyte disorders.

Cited by 65 publications

References 19 publications

Pattern of Electrolyte Imbalance in Hospitalized Diabetic Patients: Experience in a Tertiary Care Hospital

Pattern of Electrolyte Imbalance in Hospitalized Diabetic Patients: Experience in a Tertiary Care Hospital

Low extracellular potassium prolongs repolarization and evokes early afterdepolarization in human induced pluripotent stem cell-derived cardiomyocytes

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

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