Dataset Information

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

ABSTRACT:

Introduction

The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are at risk for adverse events. However, there is a paucity of evidence to support this practice. This study analyzes the association between specific hyperkalemic ECG abnormalities and the development of short-term adverse events in patients with severe hyperkalemia.

Methods

We collected records of all adult patients with potassium (K+) ?6.5 mEq/L in the hospital laboratory database from August 15, 2010, through January 30, 2015. A chart review identified patient demographics, concurrent laboratory values, ECG within one hour of K+ measurement, treatments and occurrence of adverse events within six hours of ECG. We defined adverse events as symptomatic bradycardia, ventricular tachycardia, ventricular fibrillation, cardiopulmonary resuscitation (CPR) and/or death. Two emergency physicians blinded to study objective independently examined each ECG for rate, rhythm, peaked T wave, PR interval duration and QRS complex duration. Relative risk was calculated to determine the association between specific hyperkalemic ECG abnormalities and short-term adverse events.

Results

We included a total of 188 patients with severe hyperkalemia in the final study group. Adverse events occurred within six hours in 28 patients (15%): symptomatic bradycardia (n=22), death (n=4), ventricular tachycardia (n=2) and CPR (n=2). All adverse events occurred prior to treatment with calcium and all but one occurred prior to K⁺-lowering intervention. All patients who had a short-term adverse event had a preceding ECG that demonstrated at least one hyperkalemic abnormality (100%, 95% confidence interval [CI] [85.7-100%]). An increased likelihood of short-term adverse event was found for hyperkalemic patients whose ECG demonstrated QRS prolongation (relative risk [RR] 4.74, 95% CI [2.01-11.15]), bradycardia (HR<50) (RR 12.29, 95%CI [6.69-22.57]), and/or junctional rhythm (RR 7.46, 95%CI 5.28-11.13). There was no statistically significant correlation between peaked T waves and short-term adverse events (RR 0.77, 95% CI [0.35-1.70]).

Conclusion

Our findings support the use of the ECG to risk stratify patients with severe hyperkalemia for short-term adverse events.

SUBMITTER: Durfey N

PROVIDER: S-EPMC5576635 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Publications

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

Durfey Nicole N Lehnhof Brian B Bergeson Andrew A Durfey Shayla N M SNM Leytin Victoria V McAteer Kristina K Schwam Eric E Valiquet Justin J

The western journal of emergency medicine 20170710 5

<h4>Introduction</h4>The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are at risk for adverse events. However, there is a paucity of evidence to support this practice. This study analyzes the association between specific hyperkalemic ECG abnormalities and the development of short-term adverse events in patients with severe hyperkalemia.<h4>Methods</h4>We collected records of all adult patients with potassium (K+) ≥6.5 mEq/L in the hospital laboratory database fro ...[more]

PMID: 28874951

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Dataset Information

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

Introduction

Methods

Results

Conclusion

Publications

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

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