Hyperkalemic changes during spironolactone therapy for cirrhosis and ascites, with special reference to hyperkalemic intermittent paralysis

Biochemical Risk Factors Associated With Hyperkalemia in Cirrhotic Patients

INTRODUCTION

Patients with cirrhosis suffer from fluid and electrolyte imbalance. The usually reported electrolyte disorders include hyperkalemia, hyponatremia, and hypokalemia. The regional data about the prevalence and risk factors associated with hyperkalemia in cirrhotic patients are not sufficient enough. The purpose of this study is to determine various risk factors associated with hyperkalemia, which will assist in the early detection of cirrhotic patients at risk of hyperkalemia.

METHODS

This cross-sectional study was conducted in the internal medicine and gastroenterology departments of a tertiary care hospital in Pakistan from March 2021 to June 2021. Sonographically documented liver cirrhosis patients (n=500), of either gender and between the ages of 18 and 70 years, were enrolled in the study. After enrollment, patients' demographics were noted in a self-structured questionnaire. Participant's Child-Pugh score was also noted in the questionnaire. After a detailed history, 5 mL of venous blood was drawn in two vials via phlebotomy and send to the laboratory to measure serum potassium, creatinine, albumin, and bilirubin levels.

RESULT

Out of the total 500 participants, 101 (20.2%) participants had hyperkalemia. It was significantly more prevalent in participants with Child-Pugh C class and in those with a serum creatinine of more than 1.3 mg/dL. Similarly, it was more prevalent in participants with albumin levels less than 2.5 mg/dL.

CONCLUSION

Hyperkalemia is associated with Child-Pugh class C. It has a direct relationship with serum creatinine levels which is an indicator of renal function, and an inverse relationship with serum albumin levels, an indicator of hepatic synthetic function.

Change in antikaliuretic response to potassium-sparing diuretics in patients with cirrhotic ascites

In 2 elderly patients with ascites due to hepatic cirrhosis, potassium excretion decreased during re-administration of potassium-sparing diuretics after recurrence of ascites following withdrawal of previous prolonged treatment. An exaggerated antikaliuretic response and a paradoxic rise in potassium excretion are "unpredictable" changes which may occur during administration of potassium-sparing diuretics at different times in the same patient treated with the same drug.