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Jansen MN, Safi W, Matyukhin I, Stasche F, Tennigkeit J, Ritter O, Patschan D. Beta-lactam-associated hypokalemia. J Int Med Res 2024; 52:3000605241253447. [PMID: 39161253 PMCID: PMC11334258 DOI: 10.1177/03000605241253447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/18/2024] [Indexed: 08/21/2024] Open
Abstract
The aim of this narrative review was to discuss the literature on β-lactam antibiotic-associated hypokalemia, a potentially life-threatening electrolyte disorder. The PubMed, Web of Science, Cochrane Library, and Scopus databases were searched for articles published between 1965 and 2023, using the following terms: 'hypokalemia' OR 'potassium loss' OR 'potassium deficiency' AND 'beta-lactams' OR 'penicillin' OR 'penicillin G' OR 'cephalosporins' OR 'ceftazidime' OR 'ceftriaxone' OR 'flucloxacillin' OR 'carbapenems' OR 'meropenem' OR 'imipenem' OR 'cefiderocol' OR 'azlocillin' OR 'ticarcillin'. Additional search terms were 'hypokalemia' AND 'epidemiology' AND 'ICU' OR 'intensive care unit' OR 'ER' OR 'emergency department' OR 'ambulatory' OR 'old' OR 'ageing population', and experimental (animal-based) studies were excluded. A total of eight studies were selected and discussed, in addition to nine case reports and case series. Both older and currently used β-lactam antibiotics (e.g., ticarcillin and flucloxacillin, respectively) have been associated with therapy-related hypokalemia. The incidence of β-lactam antibiotic-associated hypokalemia may be as high as 40%, thus, the issue of β-lactam-associated hypokalemia remains clinically relevant. Although other causes of hypokalemia are likely to be diagnosed more frequently (e.g., due to diuretic therapy or diarrhea), the possibility of β-lactam-induced renal potassium loss should always be considered in individuals with so-called 'unexplained hypokalemia'.
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Affiliation(s)
- Muriel-N. Jansen
- Department of Internal Medicine I - Cardiology, Nephrology and Internal Intensive Medicine Brandenburg University Hospital, Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
| | - Wajima Safi
- Department of Internal Medicine I - Cardiology, Nephrology and Internal Intensive Medicine Brandenburg University Hospital, Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
| | - Igor Matyukhin
- Department of Internal Medicine I - Cardiology, Nephrology and Internal Intensive Medicine Brandenburg University Hospital, Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
| | - Friedrich Stasche
- Department of Internal Medicine I - Cardiology, Nephrology and Internal Intensive Medicine Brandenburg University Hospital, Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
| | - Johanna Tennigkeit
- Department of Internal Medicine I - Cardiology, Nephrology and Internal Intensive Medicine Brandenburg University Hospital, Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
| | - Oliver Ritter
- Department of Internal Medicine I - Cardiology, Nephrology and Internal Intensive Medicine Brandenburg University Hospital, Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany
| | - Daniel Patschan
- Department of Internal Medicine I - Cardiology, Nephrology and Internal Intensive Medicine Brandenburg University Hospital, Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany
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Wongtanasarasin W, Meelarp N. Replacing Potassium in the Emergency Department May Not Decrease the Hospital Mortality in Mild Hypokalemia: A Propensity Score Matching Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1912. [PMID: 38003961 PMCID: PMC10672891 DOI: 10.3390/medicina59111912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background: Hypokalemia is associated with considerable morbidity and mortality, highlighting the timely correction of potassium levels as a critical medical consideration. However, the management of mild hypokalemia remains a subject of ongoing debate. This study explores the relationship between potassium replacement in the emergency department (ED) and hospital mortality in patients with mild hypokalemia. Methods: This retrospective cohort study was conducted at a tertiary care hospital, including patients who presented to the ED with mild hypokalemia, defined as potassium levels between 3.0 and 3.4 mmol/L, between 2020 and 2021. Patients diagnosed with acute coronary syndrome, diabetic ketoacidosis, hyperglycemic hyperosmolar state, and major cardiac arrhythmias were excluded. The patient cohort was then divided into two groups, based on whether they received potassium replacement in the ED. A propensity score analysis was employed to account for potential pretreatment confounding factors, including age, gender, time on ED arrival, insurance, comorbidities, serum potassium and creatinine levels, and ED length of stay. Subsequently, a multivariable logistic regression analysis, incorporating hospital length of stay and acute comorbidities, was performed post-matching to further adjust for predictive factors. The primary outcome was all-cause hospital mortality. Results: This study included a total of 1931 patients, of which 724 were matched for analysis (362 with potassium replacement and 362 without). The average age was 53.9 years, and most were male (58.5%). After adjusting for confounding factors using propensity score analysis, there was no significant difference in hospital mortality between the potassium replacement and control groups (adjusted odds ratio 0.81, 95% CI 0.36-1.79, p = 0.60). Conclusions: This study's findings indicate that replacing potassium in the ED may not lower the risk of hospital mortality in patients with mild hypokalemia. Consequently, the customary practice of potassium replacement in hospitalized patients may lack justification, and deferring the replacement until after patients leave the ED could be considered.
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Affiliation(s)
- Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA
| | - Nattikarn Meelarp
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
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Logan Ellis H, Llewellyn D, Mendis J, Whyte M. Admission plasma potassium and length of hospital stay: a meta-analysis. BMJ Open 2023; 13:e068387. [PMID: 37620271 PMCID: PMC10450050 DOI: 10.1136/bmjopen-2022-068387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE Hypokalaemia and hyperkalaemia ('dyskalaemia') are commonly seen in patients requiring emergency hospital admission. The adverse effect of dyskalaemia on mortality is well described but there are few data for the effect on hospital length of stay. We sought to determine the association of serum potassium concentration with in-hospital length of stay. DESIGN Systematic review and meta-analysis. DATA SOURCES A structured search of MEDLINE, PubMed and SCOPUS databases to 19 March 2021. ELIGIBILITY CRITERIA Observational cohort studies defining exposure of interest as serum potassium levels (at admission or within the first 72 hours) and with outcome of interest as length of hospital stay. Studies had to provide estimates of length of stay as a comparison between normokalaemia and defined ranges of hyperkalaemia or hypokalaemia. DATA EXTRACTION AND SYNTHESIS We identified 39 articles published to March 2021 that met the inclusion and exclusion criteria. Study selection, data extraction and quality assessment were carried out by two reviewers working independently and in duplicate, to assessed eligibility and risk of bias, and extract data from eligible studies. Random effects models were used to pool estimates across the included studies. Meta-analyses were performed using Cochrane-RevMan. RESULTS Five studies were included in the meta-analysis. Compared with the reference group (3.5-5.0 mmol/L), the pooled raw differences of medians were 4.45 (95% CI 2.71 to 6.91), 1.99 (95% CI 0.03 to 3.94), 0.98 (95% CI 0.91 to 1.05), 1.51 (95% CI 1.03 to 2.0), 1 (95% CI 0.75 to 1.25) and 2.76 (95% CI 1.24 to 4.29) for patients with potassium levels of <2.5, 2.5 to <3.0, 3.0 to <3.5, <5 to 5.5, <5.5 to 6 and >6.0 mmol/L, respectively. CONCLUSION Hospital length of stay follows a U-shaped distribution, with duration of admission being twofold greater at the extremes of the potassium range.
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Affiliation(s)
- Hugh Logan Ellis
- Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - David Llewellyn
- Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Jeewaka Mendis
- Clinical & Experimental Medicine, University of Surrey, Guildford, UK
| | - Martin Whyte
- Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK
- Clinical & Experimental Medicine, University of Surrey, Guildford, UK
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Chu T, Wu Z, Xu A. Association between preoperative hypokalemia and postoperative complications in elderly patients: a retrospective study. BMC Geriatr 2022; 22:743. [PMID: 36096723 PMCID: PMC9469624 DOI: 10.1186/s12877-022-03445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hypokalemia is a common form of electrolyte disorder, which has a higher incidence in hospitalized patients and is closely related to perioperative complications and prognosis. Due to decreased skeletal muscle mass which causes total body potassium reduction, and increased comorbidities, the elderly are more susceptible to hypokalemia. Objective To investigate preoperative hypokalemia in elderly patients and its effect on postoperative complications. Methods Data were retrospectively collected from the elderly patients who underwent elective surgery from April 2018 to March 2019 and had preoperative blood gas data available. Patients, with age 60 to 100 years, were divided into hypokalemia group (potassium level < 3.5 mmol/L) and normokalemia group (potassium level between 3.5 and 5.5 mmol/L) according to preoperative blood gas analysis. Hypokalemia can be divided into mild (potassium level 3.0 to 3.5 mmol/L), moderate (potassium level 2.5 to 3.0 mmol/L) and severe (potassium level < 2.5 mmol/L), respectively. The risk factors of preoperative hypokalemia and its impact on postoperative complications and prognosis were primary outcomes. Secondary outcomes included postanesthesia care unit (PACU) stay time and hospital length of stay (LOS). Results Of 987 participants, 436 (44.17%) developed preoperative hypokalemia, among them 357 (81.88%) mild, 87 (16.74%) moderate and 6 (1.38%) severe. Multivariate logistic regression showed that female gender (OR, 1.851; 95% CI, 1.415–2.421), pre-existing hypokalemia at admission (OR, 4.498; 95% CI, 2.506–8.071), and oral laxative twice or more (OR, 1.823; 95% CI, 1.266–2.624) are risk factors of preoperative hypokalemia. Gynecological and biliopancreatic surgery were more common in hypokalemia group than normokalemia group (P < 0.001, P < 0.05). There was no significant difference in postoperative complications, PACU stay time, LOS, and 30-day mortality between the two groups (all P > 0.05). Conclusions Female gender, pre-existing hypokalemia at admission, and oral laxative twice or more are independent risk factors for preoperative hypokalemia in elderly patients. However, postoperative complications and 30-day mortality were not increased, which may be related to monitoring blood gas analysis and prompt correction of potassium levels during surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03445-1.
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Affiliation(s)
- Tiantian Chu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Zongfang Wu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Aijun Xu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
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Makinouchi R, Machida S, Matsui K, Shibagaki Y, Imai N. Severe hypokalemia in the emergency department: A retrospective, single‐center study. Health Sci Rep 2022; 5:e594. [PMID: 35509383 PMCID: PMC9059213 DOI: 10.1002/hsr2.594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background and Aims Hypokalemia is one of the most common problems in the emergency department (ED). Severe hypokalemia, defined as a serum potassium level ≤2.5 mEq/L, is a relatively uncommon electrolyte disorder, and few studies have reported its prevalence, etiology, symptoms, and management in the ED. Therefore, we aimed to investigate them in this study. Methods This retrospective single‐center study included adult patients whose serum potassium levels were measured in the ED between 2012 and 2019. Data including age, sex, serum potassium levels, and serum creatinine levels were collected from the electronic medical records. Results The serum potassium levels of 21,616 adult patients were measured. The median age of these patients was 73 years (range: 57–83 years), and 38% were men. The prevalence of severe hypokalemia was 0.4%. The most common symptom of symptomatic severe hypokalemia was weakness (p = 0.001). Malnutrition, use of Japanese herbal medicine, and use of diuretics were the main causes of severe hypokalemia. Sixty‐one patients (70%) underwent electrocardiography. Fifty‐nine patients (68%) received treatment for severe hypokalemia within one day of the visit. Conclusion The management of severe hypokalemia in the ED may be suboptimal. Emergency physicians should be vigilant to avoid missing hypokalemia.
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Affiliation(s)
- Ryuichirou Makinouchi
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine Yokohama City Seibu Hospital Yokohama Kanagawa Japan
| | - Shinji Machida
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine Yokohama City Seibu Hospital Yokohama Kanagawa Japan
| | - Katsuomi Matsui
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine Yokohama City Seibu Hospital Yokohama Kanagawa Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension St. Marianna University School of Medicine Kawasaki Kanagawa Japan
| | - Naohiko Imai
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine Yokohama City Seibu Hospital Yokohama Kanagawa Japan
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Adamczak M, Chudek J, Zejda J, Bartmańska M, Grodzicki T, Zdrojewski T, Wiecek A. Prevalence of hypokalemia in older persons: results from the PolSenior national survey. Eur Geriatr Med 2021; 12:981-987. [PMID: 33830482 PMCID: PMC8463376 DOI: 10.1007/s41999-021-00484-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Hypokalemia is one of the most common electrolyte disturbances in clinical practice. There are only a few epidemiological studies analyzing the occurrence of hypokalemia in older persons. The aim of the study was to determine the prevalence of hypokalemia in the Polish older population. METHODS Serum potassium concentration was estimated in 4654 participants (2270 females and 2384 males, mean age 76.5 [11.0] years), who participated in the PolSenior study. Hypokalemia was defined as serum potassium concentration below 3.5 mmol/L. Hypokalemia was found in 39 participants (0.84%) and was significantly more frequent among females (28 females = 1.23% and 11 males = 0.46%; p = 0.003). The prevalence of hypokalemia was not related to age. Among 3303 participants suffering from arterial hypertension, 1093 were treated with potassium-losing diuretics. RESULTS Hypokalemia was significantly more frequent among hypertensive than normotensive older participants (1.06 vs. 0.30% respectively; p = 0.007) and among hypertensive participants treated with potassium losing diuretics than ones untreated with these drugs (1.96 vs. 0.46% respectively; p < 0.001). In hypertensive participants, the prevalence of hypokalemia did not depend significantly on oral supplementation of potassium (1.92 and 0.98% respectively, NS). None of 81 participants using laxative agents presented hypokalemia. CONCLUSIONS This study demonstrates that: older age seems not to appear to be a significant risk factor of hypokalemia. Hypokalemia is more often found in the older hypertensive patients treated with potassium losing diuretics, and prevention of diuretic-induced hypokalemia with oral supplementation of potassium seems to be insufficient.
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Affiliation(s)
- Marcin Adamczak
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Francuska Str. 20/24, 40-027, Katowice, Poland
| | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice, Poland
| | - Jan Zejda
- Department of Epidemiology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Magdalena Bartmańska
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Francuska Str. 20/24, 40-027, Katowice, Poland.
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Zdrojewski
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Francuska Str. 20/24, 40-027, Katowice, Poland
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