W Frank Peacock1, Zubaid Rafique1, Carol L Clark2, Adam J Singer3, Stewart Turner4, Joseph Miller5, Douglas Char6, Anthony Lagina7, Lane M Smith8, Andra L Blomkalns9, Jeffrey M Caterino10, Mikhail Kosiborod11. 1. Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas. 2. Beaumont Hospital-Royal Oak, Royal Oak, Michigan. 3. Stony Brook School of Medicine, University Medical Center, Stony Brook, New York. 4. Arena Pharmaceuticals, San Diego, California. 5. Henry Ford Hospital, Detroit, Michigan. 6. Washington University, St Louis, Missouri. 7. Wayne State University, Detroit, Michigan. 8. Wake Forest School of Medicine, Winston-Salem, North Carolina. 9. UT Southwestern Medical Center, Dallas, Texas. 10. The Ohio State University, Columbus, Ohio. 11. Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri.
Abstract
BACKGROUND: Contemporary emergency department (ED) standard-of-care treatment of hyperkalemia is poorly described. OBJECTIVE: Our aim was to determine the treatment patterns of hyperkalemia management in the ED. METHODS: This multicenter, prospective, observational study evaluated patients aged ≥ 18 years with hyperkalemia (potassium [K+] level ≥ 5.5 mmol/L) in the ED from October 25, 2015 to March 30, 2016. K+-lowering therapies and K+ were documented at 0.5, 1, 2, and 4 h after initial ED treatment. The primary end point was change in K+ over 4 h. RESULTS: Overall, 203 patients were enrolled at 14 U.S.-based sites. The initial median K+ was 6.3 (interquartile range [IQR] 5.7-6.8) mmol/L and median time to treatment was 2.7 (IQR 1.9-3.5) h post-ED arrival. Insulin/glucose (n = 130; 64%) was frequently used to treat hyperkalemia; overall, 43 different treatment combinations were employed within the first 4 h. Within 4 h, the median K+ for patients treated with medications alone decreased from 6.3 (IQR, 5.8-6.8) mmol/L to 5.3 (4.8-5.7) mmol/L, while that for patients treated with dialysis decreased from 6.2 (IQR 6.0-6.6) mmol/L to 3.8 (IQR 3.6-4.2) mmol/L. Hypoglycemia occurred in 6% of patients overall and in 17% of patients with K+ > 7.0 mmol/L. Hyperkalemia-related electrocardiogram changes were observed in 23% of all patients; 45% of patients with K+ > 7.0 mmol/L had peaked T waves or widened QRS. Overall, 79% were hospitalized; 3 patients died. CONCLUSIONS: Hyperkalemia practice patterns vary considerably and, although treatment effectively lowered K+, only dialysis normalized median K+ within 4 h.
BACKGROUND: Contemporary emergency department (ED) standard-of-care treatment of hyperkalemia is poorly described. OBJECTIVE: Our aim was to determine the treatment patterns of hyperkalemia management in the ED. METHODS: This multicenter, prospective, observational study evaluated patients aged ≥ 18 years with hyperkalemia (potassium [K+] level ≥ 5.5 mmol/L) in the ED from October 25, 2015 to March 30, 2016. K+-lowering therapies and K+ were documented at 0.5, 1, 2, and 4 h after initial ED treatment. The primary end point was change in K+ over 4 h. RESULTS: Overall, 203 patients were enrolled at 14 U.S.-based sites. The initial median K+ was 6.3 (interquartile range [IQR] 5.7-6.8) mmol/L and median time to treatment was 2.7 (IQR 1.9-3.5) h post-ED arrival. Insulin/glucose (n = 130; 64%) was frequently used to treat hyperkalemia; overall, 43 different treatment combinations were employed within the first 4 h. Within 4 h, the median K+ for patients treated with medications alone decreased from 6.3 (IQR, 5.8-6.8) mmol/L to 5.3 (4.8-5.7) mmol/L, while that for patients treated with dialysis decreased from 6.2 (IQR 6.0-6.6) mmol/L to 3.8 (IQR 3.6-4.2) mmol/L. Hypoglycemia occurred in 6% of patients overall and in 17% of patients with K+ > 7.0 mmol/L. Hyperkalemia-related electrocardiogram changes were observed in 23% of all patients; 45% of patients with K+ > 7.0 mmol/L had peaked T waves or widened QRS. Overall, 79% were hospitalized; 3 patients died. CONCLUSIONS:Hyperkalemia practice patterns vary considerably and, although treatment effectively lowered K+, only dialysis normalized median K+ within 4 h.
Authors: Jill Davis; Rubeen Israni; Fan Mu; Erin E Cook; Harold Szerlip; Gabriel Uwaifo; Vivian Fonseca; Keith A Betts Journal: Hosp Pract (1995) Date: 2021-05-26
Authors: Jill Davis; Rubeen Israni; Keith A Betts; Fan Mu; Erin E Cook; Deborah Anzalone; Harold Szerlip; Lei Yin; Gabriel I Uwaifo; Eric Q Wu Journal: Adv Ther Date: 2021-12-27 Impact factor: 3.845
Authors: Gregor Lindner; Emmanuel A Burdmann; Catherine M Clase; Brenda R Hemmelgarn; Charles A Herzog; Jolanta Małyszko; Masahiko Nagahama; Roberto Pecoits-Filho; Zubaid Rafique; Patrick Rossignol; Adam J Singer Journal: Eur J Emerg Med Date: 2020-10 Impact factor: 4.106