Acid-base / Electrolytes

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Introduction and Aims: Severe hyperkalemia (K=6.5mEq/L) is a potentially life-threatening electrolyte disorder. To treat it promptly and effectively, it is essential to know its causes, risk factors, clinical manifestations, and predictors of mortality and improvement. Methods: A total of 610 Korean patients over age 18 who were hospitalized with a diagnosis of severe hyperkalemia from August 2007 to July 2010 became the subject of this retrospective study. The medical records were reviewed. Results: Hypertension was the most common underlying medical condition, followed by diabetes and chronic kidney disease (CKD). The most common precipitating factor was metabolic acidosis, followed by acute kidney injury (AKI), drugs such as angiotensin receptor blocker, K-sparing diuretics, beta blocker, and non-steroidal anti-inflammatory drugs (NSAIDs), and infection. The higher serum potassium levels were significantly associated with the use of NSAIDs, metabolic acidosis, and the history of recurrent severe hyperkalemia. Also, mortality was strongly correlated with the severity of hyperkalemia. Changes in electrocardiogram findings were associated with higher potassium levels, but didn't increase the mortality rate themselves. The mortality rate was higher in patients with underlying disease such as malignancy and severe medical conditions including infection and bleeding. In addition, AKI in patients with normal baseline renal function and metabolic acidosis were definite predictors of mortality. Whereas, mortality rate had a lowering tendency in patients with underlying disease such as hypertension, AKI on underlying CKD, and drug-induced hyperkalemia. Conclusions: Severe hyperkalemia requiring hospitalization and prompt treatment occurred in various medical conditions. The precipitating factors were also diverse. The mortality rate was especially higher in patients with severe underlying diseases and with new-onset AKI rather than AKI on underlying CKD.

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