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Hyperkalemia hypokalemia

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https://www.readbyqxmd.com/read/29135624/potassium-chloride-sustained-release-dosing-pathway-in-an-academic-medical-center
#1
Bryan M Cook, Danielle M Carter, Heather Dell'Orfano, Lina Matta
Potassium supplementation can be administered intravenously or orally with either immediate release or sustained release formulations. Sustained release potassium chloride allows for delayed absorption and peak effects. In the inpatient setting, it is important to monitor and prevent both hypokalemia and hyperkalemia. Our tertiary-care academic hospital created a clinical pathway for sustained release potassium chloride supplementation in the inpatient population. Our clinical pathway for sustained release potassium chloride creates dosing restrictions designed to prevent hyperkalemia, while allowing exceptions for patients with high requirements...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29080909/association-between-hypo-and-hyperkalemia-and-outcome-in-acute-heart-failure-patients-the-role-of-medications
#2
Matthieu Legrand, Pierre-Olivier Ludes, Ziad Massy, Patrick Rossignol, Jiri Parenica, Jin-Joo Park, Shiro Ishihara, Khalid F AlHabib, Aldo Maggioni, Òscar Miró, Naoki Sato, Alain Cohen-Solal, Enrique Fairman, Johan Lassus, Veli-Pekka Harjola, Christian Mueller, Franck W Peacock, Dong-Ju Choi, Patrick Plaisance, Jindřich Spinar, Mikhail Kosiborod, Alexandre Mebazaa, Etienne Gayat
BACKGROUND: The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown. METHODS: Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes...
October 28, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29031359/treatment-of-abnormalities-of-potassium-homeostasis-in-ckd
#3
REVIEW
Biff F Palmer, Deborah J Clegg
Hyperkalemia, defined as serum potassium concentrations greater than 5.0 to 5.5 mEq/L, is a frequent occurrence in clinical practice because of the increasing incidence and prevalence of CKD. Patients at risk for this disorder are commonly treated with drugs that interfere in the renin-angiotensin-aldosterone system, thereby enhancing the occurrence and prevalence of this disorder. Discontinuation of these drugs because of the development of hyperkalemia deprives these patients the renal-protective and cardiovascular benefits this class of pharmacology has been shown to provide...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031358/hyperkalemia-and-hypokalemia-in-ckd-prevalence-risk-factors-and-clinical-outcomes
#4
REVIEW
Sarah Gilligan, Kalani L Raphael
Abnormalities of serum potassium are common in patients with CKD. Although hyperkalemia is a well-recognized complication of CKD, the prevalence rates of hyperkalemia (14%-20%) and hypokalemia (12%-18%) are similar. CKD severity, use of medications such as renin-angiotensin-aldosterone system inhibitors and diuretics, and dietary potassium intake are major determinants of serum potassium concentration in CKD. Demographic factors, acid-base status, blood glucose, and other comorbidities contribute as well. Both hyperkalemia and hypokalemia are associated with similarly increased risks of death, cardiovascular disease, and hospitalization...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031357/regulation-of-potassium-homeostasis-in-ckd
#5
REVIEW
Thomas D DuBose
Disturbances of potassium homeostasis can cause either hyperkalemia or hypokalemia and result in serious consequences. Although the consequences of acute and chronic hyperkalemia and treatment of these conditions in CKD have been widely appreciated by nephrologists, more recent information has focused attention on the consequences of chronic hypokalemia. Several recent studies have documented a "U-shaped" relationship between the serum [K(+)] and higher mortality in several clinical studies. The causes of dyskalemias are placed into the unique perspective of patients with CKD and its evolution with progression of CKD to later stages and focuses on the pathophysiology of these disorders...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29025765/long-term-potassium-monitoring-and-dynamics-in-heart-failure-and-risk-of-mortality
#6
Julio Núñez, Antoni Bayés-Genís, Faiez Zannad, Patrick Rossignol, Eduardo Núñez, Vicent Bodí, Gema Miñana, Enrique Santas, Francisco J Chorro, Anna Mollar, Arturo Carratalá, Jorge Navarro, Jose Luis Gorriz, Josep Lupón, Oliver Husser, Marco Metra, Juan Sanchis
Background -The prognostic value of long-term potassium monitoring and dynamics in heart failure (HF) has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute HF admission. Methods -Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling...
October 12, 2017: Circulation
https://www.readbyqxmd.com/read/28924484/diabetic-ketoacidosis-producing-extreme-hyperkalemia-in-a-patient-with-type-1-diabetes-on-hemodialysis
#7
Hodaka Yamada, Shunsuke Funazaki, Masafumi Kakei, Kazuo Hara, San-E Ishikawa
Diabetic ketoacidosis (DKA) is a critical complication of type 1 diabetes associated with water and electrolyte disorders. Here, we report a case of DKA with extreme hyperkalemia (9.0 mEq/L) in a patient with type 1 diabetes on hemodialysis. He had a left frontal cerebral infarction resulting in inability to manage his continuous subcutaneous insulin infusion pump. Electrocardiography showed typical changes of hyperkalemia, including absent P waves, prolonged QRS interval and tented T waves. There was no evidence of total body water deficit...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28866674/association-of-serum-potassium-with-all-cause-mortality-in-patients-with-and-without-heart-failure-chronic-kidney-disease-and-or-diabetes
#8
Allan J Collins, Bertram Pitt, Nancy Reaven, Susan Funk, Karen McGaughey, Daniel Wilson, David A Bushinsky
BACKGROUND: The relationship between serum potassium, mortality, and conditions commonly associated with dyskalemias, such as heart failure (HF), chronic kidney disease (CKD), and/or diabetes mellitus (DM) is largely unknown. METHODS: We reviewed electronic medical record data from a geographically diverse population (n = 911,698) receiving medical care, determined the distribution of serum potassium, and the relationship between an index potassium value and mortality over an 18-month period in those with and without HF, CKD, and/or DM...
2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28806047/electrolytes-potassium-disorders
#9
REVIEW
Taiwona L Elliott
Hypokalemia (ie, potassium levels less than 3.5 mEq/L) occurs in fewer than 1% of healthy individuals, but is present in up to 20% of hospitalized patients, 40% of patients taking diuretics, and 17% of patients with cardiovascular conditions. Hypokalemia often is asymptomatic; symptoms are more common in older adults. Common symptoms are cardiac arrhythmias and muscle weakness or pain. Management consists of intravenous potassium replacement during cardiac monitoring for patients with marked symptoms, echocardiogram (ECG) abnormalities, or severe hypokalemia (ie, level less than 3...
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28803654/temporal-pattern-and-prognostic-significance-of-hypokalemia-in-patients-undergoing-targeted-temperature-management-following-cardiac-arrest
#10
Arash Nayeri, Hannah Gluck, Eric Farber-Eger, Srikanth Krishnan, Kamran Shamsa, Michael Lee, Quinn S Wells, John A McPherson
Hypokalemia has been consistently reported as a common occurrence during targeted temperature management (TTM) in comatose survivors of cardiac arrest. We sought to better describe changes in serum potassium throughout the different stages of TTM and to assess for any prognostic significance. We analyzed a prospectively collected cohort of 240 patients treated with TTM following cardiac arrest at a tertiary care hospital between 2007 and 2014. The primary outcome was poor neurologic outcome at hospital discharge, defined as a Cerebral Performance Category score >2...
October 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28745843/evidence-based-management-of-potassium-disorders-in-the-emergency-department-digest
#11
John Ashurst, Shane R Sergent, Benjamin J Wagner, Jeremy Kim
Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed...
November 22, 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28735756/incidence-and-determinants-of-hyperkalemia-and-hypokalemia-in-a-large-healthcare-system
#12
Erik Nilsson, Alessandro Gasparini, Johan Ärnlöv, Hairong Xu, Karin M Henriksson, Josef Coresh, Morgan E Grams, Juan Jesus Carrero
BACKGROUND: Hypo- and hyperkalemia in clinical settings are insufficiently characterized and large-scale data from Europe lacking. We studied incidence and determinants of these abnormalities in a large Swedish healthcare system. METHODS: Observational study from the Stockholm CREAtinine Measurements project, including adult individuals from Stockholm accessing healthcare in 2009 (n=364,955). Over 3-years, we estimated the incidence of hypokalemia, defined as potassium<3...
October 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28717776/a-retrospective-study-of-emergency-department-potassium-disturbances-severity-treatment-and-outcomes
#13
Adam J Singer, Henry C Thode, W Frank Peacock
OBJECTIVE: Disturbances in potassium (K) levels are relatively common and may be associated with significant morbidity and mortality; however, treatments vary. Our purpose was to determine the incidence, treatments, and outcomes associated with hyperkalemia and hypokalemia in emergency department (ED) patients. METHODS: We performed a structured, retrospective review of electronic medical records of consecutive adult ED patients with K measured while in the ED. Demographic, clinical, and laboratory data as well as treatments, disposition, and in-hospital complications were collected...
June 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28697495/electrolyte-and-acid-base-abnormalities-in-infants-with-community-acquired-acute-pyelonephritis-prospective-cross-sectional-study
#14
Gregorio P Milani, Angela Grava, Mario G Bianchetti, Sebastiano A G Lava, Laura Dell''Era, Thomas Teatini, Emilio F Fossali
BACKGROUND: Retrospective case series suggest that abnormalities in fluid, electrolyte, and acid-base homeostasis may occur among infants with a febrile urinary tract infection. Potentially inaccurate laboratory methods of sodium testing have often been used. METHODS: Between January 2009 and June 2016, we managed 80 previously healthy infants (52 males and 28 females) ≥4 weeks to ≤24 months of age with their first episode of acute pyelonephritis. Ionized sodium, ionized potassium and ionized chloride were determined by direct potentiometry, as recommended by the International Federation of Clinical Chemistry...
2017: Nephron
https://www.readbyqxmd.com/read/28608260/water-electrolyte-acid-base-and-trace-elements-alterations-in-cirrhotic-patients
#15
REVIEW
Carlos G Musso, Rossina Juarez, Richard J Glassock
Chronic hepatic patients, and particularly those suffering from cirrhosis, are predisposed to different sort of water, electrolyte, acid-base, and trace elements disorders due to their altered liver function, and also to their exposition to infectious, inflammatory, oncologic, and pharmacologic variables whose combination undermines their homeostatic capability. Hyponatremia, hypokalemia, hyperkalemia, hypocalcemia, metabolic acidosis, respiratory, and metabolic alkalosis are the main internal milieu alterations in this group...
June 12, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28577687/true-rate-of-mineralocorticoid-receptor-antagonists-related-hyperkalemia-in-placebo-controlled-trials-a-meta-analysis
#16
REVIEW
Davor Vukadinović, Daniel Lavall, Aleksandra Nikolovska Vukadinović, Bertram Pitt, Stefan Wagenpfeil, Michael Böhm
BACKGROUND: Mineralocorticoid receptor antagonists (MRA) improve survival in heart failure with reduced ejection fraction but are often underused, mostly due to concerns of hyperkalemia. Because hyperkalemia occurs also on placebo, we aimed to determine the truly MRA-related rate of hyperkalemia. METHODS: We performed a meta-analysis including randomized, placebo-controlled trials reporting hyperkalemia on MRAs in patients after myocardial infarction or with chronic heart failure...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28497085/evaluation-of-water-and-electrolytes-disorders-in-severe-acute-diarrhea-patients-treated-by-who-protocol-in-eight-large-hospitals-in-tehran-a-nephrology-viewpoint
#17
Alireza Soleimani, Fatemeh Foroozanfard, Mohammad Reza Tamadon
Introduction: The most common cause of death from diarrhea is the shock caused by dehydration, electrolytes and acid-base disorders. Objectives: The aim of this study was to evaluate water and electrolytes disorders in diarrhea patients after treating severe acute diarrhea. Patients and Methods: In this study we used a historical cohort and studied patients who were hospitalized due to acute diarrhea and were similarly treated for dehydration and water and electrolyte disorders as recommended by the World Health Organization (WHO) guideline...
2017: Journal of Renal Injury Prevention
https://www.readbyqxmd.com/read/28458337/outcomes-analysis-of-surgical-and-medical-treatments-for-patients-with-primary-aldosteronism
#18
Kyeong Seon Park, Jung Hee Kim, Ye Seul Yang, A Ram Hong, Dong-Hwa Lee, Min Kyong Moon, Sung Hee Choi, Chan Soo Shin, Sang Wan Kim, Seong Yeon Kim
Patients with aldosterone-producing adenomas are treated using surgery, and patients with idiopathic hyperaldosteronism receive medical treatment using mineralocorticoid receptor antagonists (MRAs). However, the outcomes of surgical and medical treatment for primary aldosteronism (PA) remain unclear. Therefore, we compared the outcomes of surgical and medical treatment for PA and aimed to identify a specific subgroup that might benefit from medical treatment. We identified 269 patients who were treated for PA (unilateral excess: 221 cases; bilateral excess: 48 cases) during 2000-2015 at the Seoul National University Hospital and two other tertiary centers...
June 29, 2017: Endocrine Journal
https://www.readbyqxmd.com/read/28432604/phosphate-imbalance-in-patients-with-heart-failure
#19
REVIEW
E C Christopoulou, T D Filippatos, E Megapanou, M S Elisaf, G Liamis
Patients with heart failure often exhibit electrolyte abnormalities, such as hyponatremia or hypokalemia/hyperkalemia. Although not as common as the other electrolyte disturbances observed in patients with heart failure, phosphate imbalance is also of high importance in this population. The aim of this review is to present the mechanisms of low or high phosphate serum levels in patients with heart failure and its role in the pathogenesis and progression of heart dysfunction. Hypophosphatemia in patients with heart failure may be the result of co-existing electrolyte and acid-base abnormalities, pharmacological treatments, decreased intestinal absorption or secondary to sympathetic nervous system activation and co-morbidities, such as diabetes mellitus or heavy alcohol consumption...
May 2017: Heart Failure Reviews
https://www.readbyqxmd.com/read/28402156/efficacy-and-safety-of-patiromer-in-hyperkalemia
#20
Saibal Das, Jayanta Kumar Dey, Sumalya Sen, Rishav Mukherjee
BACKGROUND: Patients at the highest risk of hyperkalemia are those with chronic kidney disease (CKD) stages 3 and 4. OBJECTIVE: To evaluate the efficacy and safety of patiromer in hyperkalemia in patients with heart failure or CKD. METHODS: The Cochrane Renal Group's Specialized Register was searched through contact with the Trials' Search Coordinator. We aimed at including randomized controlled trials with patiromer in patients with developed or risks of developing hyperkalemia, comparing against an active comparator or placebo...
January 1, 2017: Journal of Pharmacy Practice
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