Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter February 22, 2021

Incidence, characteristics and outcomes among inpatient, outpatient and emergency department with reported high critical serum potassium values

  • Wei-Hung Kuo , Huey-Ling You , Wan-Ting Huang , Yueh-Ting Lee , Terry Ting-Yu Chiou , Hwee-Yeong Ng and Chien-Te Lee

Abstract

Objectives

Severe hyperkalemia can cause life-threatening arrhythmia, cardiac arrest, or death. This study aimed to investigate the incidence and the associated factors relevant to critical hyperkalemia (≥6 mmol/L) among inpatients, outpatients, and emergency department. Their clinical outcomes were also analyzed.

Methods

All patients whose high serum potassium values had been reported as critical laboratory values in 2016 were enrolled. Their demographic data, comorbidities, clinical symptoms, biochemical data, and outcomes were reviewed and collected. The Charlson comorbidity score (CCS) and glomerular filtration rate (GFR) were computed to assess the comorbidity burden and renal function. Patients were divided into groups according to different settings, potassium and GFR levels, and their survival.

Results

Of the 293,830 total serum potassium tests, 1,382 (0.47%) reports were listed as critical laboratory values. The average reply time was 6.3 min. Their mean age was 67.2 years, while the average GFR was 12.2 mL/min/1.73 m2. The overall mortality rate was 34%. Patients in the emergency department had the highest incidence (0.92%), while inpatients had the worst outcome (51% mortality). The leading cause of mortality was septic shock. The fatal group had higher rates of clinical symptoms, higher potassium values, CCS, and eGFR (all p<0.05).

Conclusions

Most of the responses for the reports were obtained within a short period of time. Patients with reported high critical serum potassium values were characterized by high rates of comorbidity, reduced eGFR, and mortality. The incidence, clinical manifestations, and outcomes varied in the different clinical settings.


Corresponding author: Prof. Chien-Te Lee, Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung833, Taiwan, Phone: +886 7 7317123, Ext. 8306, Fax: +886 7 7322402, E-mail:

  1. Research funding: None declared.

  2. Author contributions: Chien-Te Lee and Wei-Hung Kuo: conceived and designed the study, analyzed the data, and wrote the first draft of the manuscript; Yueh-Ting Lee: analyzed the data and edited the manuscript; Huey-Ling You and Wan-Ting Huang: provided laboratory data and edited the manuscript; Terry Ting-Yu Chiou and Hwee-Yeong Ng: edited the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Ethical approval: The study was reviewed and approved by the Institutional Review Board of Chang Gung Memorial Hospital (201801819B0).

References

1. Lundberg, GD. When to panic over abnormal values. Med Lab Obs 1972;4:47–54.Search in Google Scholar

2. Abuelo, JG. Treatment of severe hyperkalemia: confronting 4 fallacies. Kidney Int Rep 2017;3:47–55. https://doi.org/10.1016/j.ekir.2017.10.001.Search in Google Scholar

3. Montford, JR, Linas, S. How dangerous is hyperkalemia? J Am Soc Nephrol 2017;28:3155–65. https://doi.org/10.1681/asn.2016121344.Search in Google Scholar

4. Bouadma, L, Mankikian, S, Darmon, M, Argaud, L, Vinclair, C, Siami, S, et al.. Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients. Crit Care 2019;23:415. https://doi.org/10.1186/s13054-019-2679-z.Search in Google Scholar

5. Thongprayoon, C, Cheungpasitporn, W, Hansrivijit, P, Mao, MA, Medaura, J, Bathini, T, et al.. Admission serum potassium levels in hospitalized patients and one-year mortality. Medicines (Basel) 2019;7:2. https://doi.org/10.3390/medicines7010002.Search in Google Scholar

6. Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–51. https://doi.org/10.1016/0895-4356(94)90129-5.Search in Google Scholar

7. Legrand, M, Jacquemod, A, Gayat, E, Collet, C, Giraudeaux, V, Launay, JM, et al.. Failure of renal biomarkers to predict worsening renal function in high-risk patients presenting with oliguria. Intensive Care Med 2015;41:68–76. https://doi.org/10.1007/s00134-014-3566-3.Search in Google Scholar PubMed

8. Zhou, F, Zhao, B, Gu, D. Evaluation of laboratory critical serum potassium values and their association with clinical symptoms in Chinese Han patients. J Int Med Res 2015;43:851–61. https://doi.org/10.1177/0300060515576011.Search in Google Scholar PubMed

9. Howanitz, JH, Howanitz, PJ. Evaluation of total serum calcium critical values. Arch Pathol Lab Med 2006;130:828–30. https://doi.org/10.5858/2006-130-828-eotscc.Search in Google Scholar PubMed

10. Saffar, H, Abdollahi, A, Hosseini, AS, Torabi Farsani, M, Hajinasrollah, G, Mohaghegh, P. Necessity of routine repeat testing of critical values in various working shifts. Iran J Pathol 2020;15:161–6. https://doi.org/10.30699/ijp.2020.99403.1980.Search in Google Scholar PubMed PubMed Central

11. Arbiol-Roca, A, Corral-Comesaña, S, Cano-Corres, R, Castro-Castro, MJ, Dastis-Arias, M, Dot-Bach, D. Analysis of laboratory critical values at a referral Spanish tertiary university hospital. Biochem Med 2019;29:010704. https://doi.org/10.11613/bm.2019.010704.Search in Google Scholar

12. Howanitz, JH, Howanitz, PJ. Evaluation of serum and whole blood sodium critical values. Am J Clin Pathol 2007;127:56–9. https://doi.org/10.1309/q3y27qqlel19340a.Search in Google Scholar

13. Agarwal, R, Chhillar, N, Tripathi, CB. Study of variables affecting critical value notification in a laboratory catering to tertiary care hospital. Indian J Clin Biochem 2015;30:89–93. https://doi.org/10.1007/s12291-013-0409-x.Search in Google Scholar PubMed PubMed Central

14. Park, HI, Min, WK, Lee, W, Park, H, Park, CJ, Chi, HS, et al.. Evaluating the short message service alerting system for critical value notification telephones via PDA telephones. Ann Clin Lab Sci 2008;38:149–56.Search in Google Scholar

15. Kuperman, GJ, Teich, JM, Tanasijevic, MJ, Ma’Luf, N, Rittenberg, E, Jha, A, et al.. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inf Assoc 1999;6:512–22. https://doi.org/10.1136/jamia.1999.0060512.Search in Google Scholar PubMed PubMed Central

16. Etchells, E, Adhikari, NK, Cheung, C, Fowler, R, Kiss, A, Quan, S, et al.. Real-time clinical alerting: effect of an automated paging system on response time to critical laboratory values—a randomised controlled trial. Qual Saf Health Care 2010;19:99–102. https://doi.org/10.1136/qshc.2008.028407.Search in Google Scholar PubMed

17. Piva, E, Sciacovelli, L, Zaninotto, M, Laposata, M, Plebani, M. Evaluation of effectiveness of a computerized notification system for reporting critical values. Am J Clin Pathol 2009;131:432–41. https://doi.org/10.1309/ajcpys80bucbxtuh.Search in Google Scholar PubMed

18. Rayan, N, Baird, R, Masica, A. Rapid response team interventions for hyperkalemia: evaluation of a patient safety initiative. Hosp Pract 2011;39:161–9. https://doi.org/10.3810/hp.2011.02.387.Search in Google Scholar PubMed

19. An, JN, Lee, JP, Jeon, HJ, Kim, DH, Oh, YK, Kim, YS, et al.. Severe hyperkalemia requiring hospitalization: predictors of mortality. Crit Care 2012;16:R225. https://doi.org/10.1186/cc11872.Search in Google Scholar PubMed PubMed Central

20. Paice, B, Gray, JM, McBride, D, Donnelly, T, Lawson, DH. Hyperkalemia in patients in hospital. Br Med J 1983;286:1189–92. https://doi.org/10.1136/bmj.286.6372.1189.Search in Google Scholar PubMed PubMed Central

21. Henz, S, Maeder, MT, Huber, S, Schmid, M, Loher, M, Fehr, T. Influence of drugs and comorbidity on serum potassium in 15000 consecutive hospital admissions. Nephrol Dial Transplant 2008;23:3939–45. https://doi.org/10.1093/ndt/gfn380.Search in Google Scholar PubMed

22. Takaichi, K, Takemoto, F, Ubara, Y, Mori, Y. Analysis of factors causing hyperkalemia. Intern Med 2007;46:823–9. https://doi.org/10.2169/internalmedicine.46.6415.Search in Google Scholar PubMed


Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-1476).


Received: 2020-10-05
Accepted: 2021-02-08
Published Online: 2021-02-22
Published in Print: 2021-06-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 29.3.2024 from https://www.degruyter.com/document/doi/10.1515/cclm-2020-1476/html
Scroll to top button