Details

Autor(en) / Beteiligte

• Fordjour, Kristy N., PharmD
• Walton, Ted, PharmD
• Doran, John J., MD

Titel

Management of Hyperkalemia in Hospitalized Patients

Ist Teil von

• The American journal of the medical sciences, 2014-02, Vol.347 (2), p.93-100

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2014

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Purpose The aim of this study was to determine the incidence of treatment of hyperkalemia in hospitalized patients. Methods This is a prospective chart review of adults in a tertiary care hospital with hyperkalemia (serum potassium [K+ ] ≥ 5.1 mEq/L) over a 6-month period. The treatments and their effectiveness, causative factors and associated electrocardiographic (ECG) changes were examined. Results There were 154 hyperkalemic episodes, 32 with K+ ≥ 6.5 mEq/L and 122 with K+ < 6.5 mEq/L. Overall, 97% received treatment for an average K+ of 5.9 mEq/L. Sodium polystyrene sulfonate (SPS) was included in 95% of the regimens. incremental doses of sPs monotherapy yielded potassium reductions between 0.7 and 1.1 mEq/L, and inadequate responses (K+ < 0.5 mEq/L) were less frequent with higher doses. There were no differences in the effectiveness of SPS among dialysis-dependent, chronic kidney disease, or nonchronic kidney disease patients. Greater reductions in potassium were observed using a combination of treatments. ECGs were performed in 44% of patients, and 50% showed no ECG changes despite K+ being ≥ 6.5 mEq/L. The most common abnormality, peaked T waves, was associated with a higher frequency of calcium administration but not with the number of K+ -lowering therapies. Conclusions Almost all the patients were treated for hyperkalemia. Oral SPS monotherapy was the predominant treatment with the best response at the highest dose. Some combination therapies had greater K+ reductions but were used infrequently. An ECG was obtained in about 50% of the cases, but two thirds showed no K+ -related changes. Reduced kidney function was associated with 70% of hyperkalemic episodes. Angiotensin-converting enzyme inhibitors and trimethoprim were the most commonly implicated medications.