of varying disease states and the pharmacology of medications used to ... 1Duquesne University School of Pharmacy, Pittsburgh PA; 2UPMC Mercy Hospital, ...
Evaluation of the safety and efficacy of potassium supplementation in the non-intensive care unit setting
Poster
Benton Miller, Jessica Nero, Victoria Nesbitt, Vanessa Rohm; PharmD candidates 2018; Jordan R Covvey, PharmD, PhD, BCPS1; David E Zimmerman, PharmD, BCPS, BCCCP1,2; Anthony J Guarascio, PharmD, BCPS1,3; Branden D Nemecek, PharmD, BCPS1,2 1Duquesne University School of Pharmacy, Pittsburgh PA; 2UPMC Mercy Hospital, Pittsburgh, PA; 3Allegheny General Hospital, Pittsburgh PA
Hypokalemia is the most common electrolyte abnormality seen in hospitalized patients, experienced by approximately 20% and associated with increased morbidity and mortality1,2 Serum potassium levels can be further affected by the pathophysiology of varying disease states and the pharmacology of medications used to treat various conditions There are currently no universally accepted recommendations regarding the replacement of potassium in the inpatient setting Both the lack of treatment of low serum potassium and overcorrection with potassium supplementation may cause adverse effects such as muscle weakness and cardiac arrhythmias3
A total of 314 patients were included in the study with the most common cause of admission being cardiac or cardiopulmonary complaint
0.4
Overall there were 664 total doses of potassium given (13.7% intravenous)
0.35
Six episodes of hyperkalemia (K+ > 5.5 mEq/L) were documented, of these, four patients received treatment for hyperkalemia
Across all patients, the mean change in potassium was 0.272 (± 0.45) mEq/L; the mean change per 10 mEq was 0.075 (± 0.31) mEq/L
Differences were observed in increases of potassium between genders, with more change occurring in the female population
Potassium-altering medications increased potassium levels as expected based on each of their previously studied effects on serum potassium
In this acutely ill population, the common dogma of an increase of 0.1 mEq/L of serum K per every 10 mEq administered was not found
This research contributes to the relative lack of literature available regarding potassium supplementation
Limitations of this study included sample size, inconsistent timing of laboratory data, and the retrospective design
Average Change in Serum Table 1: Patient characteristics (n=314) Basic demographics Male
n (%) 122 (38.8)
Race Caucasian African-American Other
194 (61.8)
Increase in K+ (mEq/L)
RESULTS/DISCUSSION
RESULTS/TABLES
BACKGROUND
119 (37.9)
K+
After Supplementation
0.3 0.25 0.2 0.15 0.1 0.05
1 (0.32)
0
OBJECTIVE To evaluate the safety and efficacy of oral/intravenous potassium supplementation in hospitalized patients
METHODS
Retrospective chart review including adult patients who received oral or intravenous potassium supplementation in the non-intensive care unit (ICU) inpatient setting between 2014 and 2017
Age
67.7 (12.8)
BMI
29.8 (8.5)
Inpatient days before*
1.85 (2.47)
Inpatient days after*
3.77 (3.85)
Total inpatient days
6.61 (4.62)
FUTURE DIRECTIONS
0.09 Comorbidities
n (%)
Data collected included patient demographics and clinical characteristics, comorbidities, receipt of potassium supplementation, receipt of any additional potassium-altering therapies, and any documented treatment for hyperkalemia
Alcoholism
35 (11.1)
CKD
21 (6.7)
Malnutrition
7 (2.2)
All oral and intravenous potassium supplementation was recorded including number of doses, total daily dose, and timing of doses around laboratory draws
Gastric bypass
6 (1.9)
CHF
51 (16.2)
Serum lab values were recorded at baseline, discharge, and up to five days following the first dose of potassium supplementation. Hemolyzed serum potassium levels were excluded from data analysis
DM
95 (30.2)
Hypertension
217 (69.1)
0.08
Additional data collection to increase power and further evaluate contributing factors
Identification of risk factors through regression analysis for lack of response to therapy as well as risk factors for heightened response to therapy
0.07 0.06 0.05 0.04 0.03 0.02 0.01
AUTHOR DISCLOSURES Jordan Covvey – Previous/current funding from Novartis Pharmaceuticals and CPNP Foundation unrelated to this work All other authors – Nothing to disclose
0
Microsoft Excel (Redmond, WA) was utilized for analysis This study was approved by both the University of Pittsburgh and Duquesne University Institutional Review Board (IRB)
Change in Serum K+ per 10 mEq Supplementation Increase in K+ (mEq/L)
Mean (SD)
*Before/after first potassium supplementation BMI: body mass index; CKD: chronic kidney disease; CHF: congestive heart failure; DM: diabetes mellitus
REFERENCES 1. Jordan M, Caesar J. BMJ. 2015;4(1):u209049.w3670. 2. Crop M, et al. Nephrol Dial Transplant. 2017;22:3471-3477. 3. Rastergar A, Soleimani M. Postgrad Med J. 2001;77:759-764.
