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Title: | Hyperkalaemia in the emergency department: Epidemiology, management and monitoring of treatment outcomes. | Austin Authors: | Pollack, Kimberley;Manning, Kiri R;Balassone, Jacqueline;Bui, Calista;Taylor, David McD ;Taylor, Simone E | Affiliation: | Pharmacy Emergency Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia Middlemore Hospital, Auckland, New Zealand |
Issue Date: | 11-Apr-2022 | Date: | 2022 | Publication information: | Emergency Medicine Australasia : EMA 2022; 34(5): 751-757 | Abstract: | To describe the epidemiology, treatment and monitoring of treatment outcomes of patients presenting to the ED with hyperkalaemia. We undertook a retrospective observational study in a mixed adult/paediatric ED over five 3-month periods. Consecutive patients were included if they had an initial serum or blood gas potassium ≥6.0 mmol/L. Patients were excluded if their principal diagnosis was diabetic ketoacidosis, their blood sample was haemolysed or the blood gas result was inconsistent with a subsequent serum potassium. Data were extracted from electronic medical records and two senior emergency registrars independently assessed available ECGs. Moderate and severe hyperkalaemia were potassium 6.0-6.4 and ≥6.5 mmol/L, respectively. Overall, 392 patients were included (mean age 73.7 years, triage category 1 or 2 28.3%, admitted 91.3%). Three hundred and twenty-one (81.9%, 95% confidence interval [CI] 77.6-85.5%) patients took one or more medications that predispose to hyperkalaemia and 335 (85.5%, 95% CI 81.5-88.7%) had one or more predisposing comorbidities. Two hundred and seventy-one (69.1%, 95% CI 64.3-73.6%) patients had moderately severe and 121 (30.9%, 95% CI 26.4-35.7%) had severe hyperkalaemia. Two hundred and fifty-nine (66.1%, 95% CI 61.1-70.7%) patients were administered at least one medication in ED to lower the potassium concentration and 51 (13.0%, 95% CI 9.9-16.8%) were dialysed. One hundred and eighty-seven patients received intravenous insulin: 40 (21.4%) had documented biochemical hypoglycaemia, but 45 (24.1%) had no post-insulin blood glucose level documented. Hyperkalaemia-associated ECG changes were uncommon. Most ED patients with hyperkalaemia have identifiable clinical and medication-related risk factors. Variations in care were widespread and monitoring for iatrogenic adverse events was suboptimal. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/29931 | DOI: | 10.1111/1742-6723.13971 | ORCID: | https://orcid.org/0000-0002-8986-9997 https://orcid.org/0000-0002-0592-518X |
Journal: | Emergency Medicine Australasia : EMA | PubMed URL: | 35411698 | PubMed URL: | https://pubmed.ncbi.nlm.nih.gov/35411698/ | Type: | Journal Article | Subjects: | emergency service hospital hyperkalaemia/drug therapy insulin potassium |
Appears in Collections: | Journal articles |
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