Background: Hypokalaemia (potassium below 3.5 mmol/l) is a common electrolyte abnormality associated with cardiac instability and myopathies. Untreated hypokalaemia can lead to inpatient morbidity and mortality.1
Aim: To review the management of hypokalaemia, in terms of potassium replacement therapy, potassium-level monitoring and cardiac monitoring, in Maidstone hospital.
Methods: A cross-sectional study of inpatients with hypokalaemia over 3 weeks. Clinical notes were used to compare management to trust guidelines.
Results: Of the 51 patients (female: male ratio 2:1, mean age 71 years) identified, 63% received no potassium replacement and only 26% were managed according to trust guidelines. The majority (74%) of mild hypokalaemia (potassium 3.03.4 mmol/l, n=39) was not actively corrected, whilst 10% of moderate hypokalaemia (potassium 2.52.9 mmol/l, n=10) and 50% of severe hypokalaemia (potassium below 2.5 mmol/l, n=2) were also untreated. Potassium replacement therapy was poorly standardised; 40% of initial replacement for mild hypokalaemia was i.v. instead of oral, and replacement regimes for moderate-severe hypokalaemia were variable. Daily potassium-level monitoring until normokalaemia occurred in 66% of patients. During intravenous potassium therapy, 46% had repeat potassium levels after every 40 mmol administered. All cases of severe hypokalaemia had magnesium levels checked. Few patients (17%) with moderate-severe hypokalaemia received a repeat ECG. No patients had cardiac monitoring during intravenous potassium administration.
Conclusion and discussion: This audit demonstrates inadequate hypokalaemia management in our DGH a malpractice we believe is shared across other DGHs. Lack of education and consensus on hypokalaemia management amongst doctors was a main contributing factor to the poor practice. This highlights the need for society-led guidelines on the management of inpatient hypokalaemia at a national level.
1. Alfonzo et al. Potassium disorders-clinical spectrum and emergency treatment. Resuscitation 2006 70 1025