Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department

PLoS One. 2020 Aug 4;15(8):e0236934. doi: 10.1371/journal.pone.0236934. eCollection 2020.

Abstract

Background: Potassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described.

Aims: This study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness.

Methods: Post-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete self-medication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed.

Results: A total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemia<4mmol/L(n = 620, 49.9%), normokalemia 4-5mmol/L(n = 549, 44.2%) and hyperkalemia >5mmol/L(n = 73, 0,6%). The proportion of patients with a kalemia<3.5mmol/L was 8% (n = 101). Renal insufficiency (OR [95% CI] = 3.56[1.94-6.52], p-value <0.001) and hemoglobin <12g/dl (OR [95% CI] = 2.62[1.50-4.60], p-value = 0.001) were associated with hyperkalemia. Female sex (OR [95% CI] = 1.31[1.03-1.66], p-value = 0.029), age <45years (OR [95% CI] = 1.69 [1.20-2.37], p-value = 0.002) and the use of thiazide diuretics (OR [95% CI] = 2.04 [1.28-3.32], p-value = 0.003), were associated with hypokalemia<4mmol/l. Two patients died in the ED and 629 (52.7%) were hospitalized. Hypokalemia <3.5mmol/L was independently associated with increased odds of hospitalization or death (OR [95% CI] = 1.47 [1.00-2.15], p-value = 0.048).

Conclusions: Hypokalemia is frequently found in the ED and was associated with worse outcomes in a low-risk ED population.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cross-Sectional Studies
  • Emergency Medical Services*
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Hypokalemia / complications
  • Hypokalemia / epidemiology*
  • Hypokalemia / mortality
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Treatment Outcome

Grants and funding

The National Medicine Academy approved the study design and provided funding. The French Society for Clinical Pharmacy (SFPC) approved the protocol, supported the enrolment and training of pharmacy students and provided funding. The French Association of Pharmaceutical Manufacturers for a responsible self-medication (AFIPA) approved the protocol and the conduct of the study. Sanofi Aventis approved the protocol and the conduct of the study. Patrick Rossignol reports receiving consulting fees and travel support from Novartis, consulting fees from Novo Nordisk, AstraZeneca, Grünenthal, and Corvidia, consulting fees, lecture fees, fees for serving on a steering committee, and travel support from Relypsa/Vifor/Vifor Fresenius Medical Care, fees for serving on a steering committee and fees for serving on a critical event committee from Idorsia, lecture fees and travel support from Bayer and Servier, owning stock options in G3 Pharmaceuticals, and fees for serving as co-founder and owning stock in CardioRenal. TC reports honoraria from Novartis, Astra Zeneca. ML reports receiving lecture fees from Baxter and Fresenius, research support from Sphingotec, and consulting fees from Novartis. None of these funding sources intervened in the collection, management, analysis or interpretation of the data; nor in the preparation, review or approval of the manuscript.