Hyperkalemia in a district general hospital
Surya P Rajeev1, Satheesh B Nair2, Muhammed Muzaffar Mahmood1, John Geen1 & Piero Baglioni1
Objectives: To assess the aetiology and management of hyperkalemia amongst inpatients in a district general hospital.
Methods: Individuals with hyperkalemia (defined as potassium>6.5 mmol/L) were identified from a biochemistry lab database. Review of case records in a six month period to assess the aetiology and management. Patients on renal replacement therapy and those<18 years were excluded.
Results: 45 patients were identified from the database. 34 had true hyperkalemia (mean age 68±14 years, males 27, only 3 aged<50 years. 11 patients had pseudohyperkalemia (due to haemolysis of laboratory specimen). Causes were drugs in 53%, acute renal failure in 32%, sepsis in 12% and rhabdomyolysis in 3%. Drugs causing hyperkalemia (total 18) included ACEI 13, ARB 2, spironolactone +ACEI/ARB 6, spironolactone alone 2, trimethoprim 1.
29% had ECG changes due to hyperkalemia. 47% did not have ECG after the detection of hyperkalemia. 47% were treated with Calcium gluconate and Insulin dextrose, 14% with Calcium resonium and Insulin dextrose, 9% with Insulin dextrose alone, 3% had Calcium gluconate and Salbutamol nebulisation, 6% had haemofiltration. 7 patients were not given any treatment and died (4 not for resuscitation, 2 died before haemofiltration, 1 died due to burns). 5 patients received treatment, but died.
Conclusions: Drugs and renal failure were the most common causes of hyperkalemia. The most common age group affected was>50 years. Combination of ACEI/ARB with spironolactone contributed to hyperkalemia in 33% of the patients in whom drugs were a cause.