Abstract
Background
Hyperkalemia (HK) is common and associated with mortality. Our purpose was to determine
if the rapid correction of elevated serum potassium level (K+) was associated with reduced mortality in emergency department (ED) patients.
Methods
Design: We reviewed the electronic medical records (EMR) of ED patients with HK (K+ ≥ 5.5 mEq/L) from 10/2016–10/2017. Setting: Large, academic ED. Participants: Adult ED patients presenting with hyperkalemia. Main outcomes and measures: The main outcome was in-hospital mortality. We compared outcomes of patients whose
K+ normalized (dropped below 5.5 mEq/L) with those whose K+ did not normalize using chi-square and multivariate analyses to determine the associations
between predictor variables and outcomes.
Results
From 114,977 ED visits, 1033 patients (0.9%, 95%CI 0.85–0.95%) had HK. Their mean
(SD) age was 60 (26) years and 58% were male. Of these, 884 had a second K+ measured within a median (IQR) of 5 (3–8) hours. Mortality and admission rates were
higher in patients with HK vs. those with normal K+ (8.5% vs. 0.8%, P < 0.001 and 80% vs. 39%, P < 0.001, respectively). Mortality was lower in patients
whose HK normalized compared with those whose K+ remained elevated (6.3% vs. 12.7%, P = 0.001). After adjusting for age, creatinine, comorbidities, and initial K+, normalization of K+ was associated with reduced mortality (OR 0.47, 95%CI 0.28 to 0.80).
Conclusions
Normalization of K+ during the ED stay in patients with HK is associated with a 50% mortality reduction.
Efforts to rapidly identify and treat HK in the ED are needed.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
PDF Download and 24 Hours Online AccessSubscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in emergency room visits due to hyperkalemia in the United States.Value Health. 2015; 18: A386
- Relation of electrolyte disturbances to cardiac arrhythmias.Circulation. 1973; 47: 408-419
- Relationship between electrocardiogram and electrolytes.Am Heart J. 1967; 73: 814-834
- Severe hyperkalemia: can the electrocardiogram risk stratify for short-term adverse events?.West J Emerg Med. 2017; 18: 963-971
- A retrospective study of ED K+ disturbances: severity, treatment and outcomes.Clin Exp Emerg Med. 2017; 4: 73-79
- Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes.Arch Med Sci. 2014; 10: 251-257
- Severe hyperkalemia requiring hospitalization: predictors of mortality.Crit Care. 2012; 16: R225
- Predictors of hyperkalemia and death in patients with cardiac and renal disease.Am J Cardiol. 2012; 109: 1510-1513
- Serum K+ levels and mortality in acute myocardial infarction.JAMA. 2012; 307: 157-164
- Association between hyperkalemia at critical care initiation and mortality.Intensive Care Med. 2012; 38: 1834-1842
- Real world evidence for treatment of hyperkalemia in the emergency department (REVEAL-ED): a multicenter, prospective, observational study.J Emerg Med. 2018; 55: 741-750
- Chart reviews in emergency medicine research: where are the methods?.Ann Emerg Med. 1996; 27: 305-308
- Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies.Ann Emerg Med. 2014; 64: 292-298https://doi.org/10.1016/j.annemergmed.2014.03.025
- New method classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Burden of hyperkalemia and treatment patterns in the emergency department setting: results from the REVEAL-ED study.Ann Emerg Med. 2016; 68: S1-S2
- Effects of presentation and electrocardiogram on time to treatment of hyperkalemia.Acad Emerg Med. 2008; 15: 239-249
Article Info
Publication History
Published online: December 10, 2019
Accepted:
December 3,
2019
Received in revised form:
November 18,
2019
Received:
July 31,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
