Hyperkalemia in Hospitalized Patients: Causes, Electrocardiographic Findings, Adequacy of Treatment, and an Attempt to Improve Physician Compliance with Published Therapy Guidelines
Skarlet W. Patino Velasuquez. cardiology, University Of Puerto Rico, San Juan, Puerto Rico, United States
Purpose of Study Hyperkalemia is a common, potentially life-threatening disorder. It can cause severe cardiac electro physiologic alterations, such as cardiac arrhythmias and sudden cardiac death. ECG are considered to be sensitive indicators of the presence of hyperkalemia. Since the treatment of hyperkalemia involve relatively few maneuvers and because its success it can be subjectively evaluated, we investigated how physicians manage this disorder and how successful the prescribed therapy is. We also sought to determine whether time and treatment could be improved by providing the treating physician intra-hospital protocol with therapeutic guidelines and real time basis.
Methods Used Is a retrospective observational study where patients with hyperkalemia where identified by reviewing laboratory records with panic values reported. During the study demographic data, contributory causes, electrocardiographic findings, treatment used, complications and patient's outcomes where recorded
Summary of Results They where 230 episodes of hyperkalemia during the period of study. Only (2%) of patient's died and had alive threatening cardiac arrhythmia due to hyperkalemia Electrocardiographic abnormalities consistent with hyperkalemia where observed in (34%) of patients. Renal failure was found in (77%), drugs (63%) and hyperglycemia (46%) as contributors to most episodes. Treatment used where exchange resins (60%), insulin (42%), calcium Gluconate (33%), albuterol (3%) and hemodialysis (37%). Average time to treatment was 2.5 hrs [95% CI:-2.9-7.9]. Physician's compliance with protocol after notification of panic values were 31.5%
Conclusions Treatment of hyperkalemia at Mayagüez Medical Center was found suboptimal. An efforts to improve physician's compliance with the published therapeutic guidelines need to be implemented. We propose to establish a protocol of management to be activated at the time of panic value report, to decrease complications, cost and miss use of medications.
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