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Predictors of Outcome in Patients Presenting with Moderate to Severe Hyperkalemia

Badar Afzal, Amber Mehmood, Sana Shahbaz, Sarah Kabir and Tahir Khan Zai

Introduction
One of the most common electrolyte imbalance observed in Emergency Departments (ED) is hyperkalemia [Potassium (K) level >5.5 mEq/dL]. Moderate to severe hyperkalemia (K level >6.0 mEq/ dL) may cause serious arrhythmias therefore it is important to correct hyperkalemia promptly and treat the underlying cause.

Objective
The aim of this study is to assess patients with moderate to severe hyperkalemia presenting in the emergency department. Also, we will be considering patient mortality and factors associated with hyperkalemia.

Methods
The study was conducted in Aga Khan University Hospital Department of Emergency Medicine during November 2008-October 2009. All adult patients (age ≥ 16) who visited ED with moderate to severe hyperkalemia were included. Complete medical charts of all the eligible patients were reviewed and relevant information was collected in the data collection tool. Data was analyzed using SPSS v16, along with the calculation of frequencies and proportions of categorical data. 2×2 tables were used to assess the association between hyperkalemia vs. age, sex, co morbidities, presenting complaints, presence of hypotension and chronic kidney disease. Statistically significant variables were entered into a multiple logistic regression model to determine the strength of association.

Results
There were a total 247 eligible patients, out of whom 51.8% were males and rest were females. 45% patients were between 46-65 years of age while 43% were above 65 years of age with only 12.3% patients between 15-45 years. 29% patients had 1-2 Comorbid conditions, whereas 69% of patients had ≥ 3 comorbids. Survival data was available for 213 patients; out of whom 186 (87.3%) patients survived till discharge. Of expired, 89% patients had K level 6.0-7.0 mEq/dL and only 11% had K level of >7.0 mEq/dL. Age, coronary artery disease, high anion gap and moderate hyperkalemia were negatively associated with survival.

Conclusion
In patients presenting with hyperkalemia, increasing age, high anion gap metabolic acidosis and moderate hyperkalemia (K level 6.0-7.0 mEq/dL) are chief predictors of mortality.