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Incidence, characteristics and outcomes among inpatient, outpatient and emergency department with reported high critical serum potassium values

  • Wei-Hung Kuo , Huey-Ling You , Wan-Ting Huang , Yueh-Ting Lee , Terry Ting-Yu Chiou , Hwee-Yeong Ng and Chien-Te Lee
Published/Copyright: February 22, 2021
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 59 Issue 7

Abstract

Objectives

Severe hyperkalemia can cause life-threatening arrhythmia, cardiac arrest, or death. This study aimed to investigate the incidence and the associated factors relevant to critical hyperkalemia (≥6 mmol/L) among inpatients, outpatients, and emergency department. Their clinical outcomes were also analyzed.

Methods

All patients whose high serum potassium values had been reported as critical laboratory values in 2016 were enrolled. Their demographic data, comorbidities, clinical symptoms, biochemical data, and outcomes were reviewed and collected. The Charlson comorbidity score (CCS) and glomerular filtration rate (GFR) were computed to assess the comorbidity burden and renal function. Patients were divided into groups according to different settings, potassium and GFR levels, and their survival.

Results

Of the 293,830 total serum potassium tests, 1,382 (0.47%) reports were listed as critical laboratory values. The average reply time was 6.3 min. Their mean age was 67.2 years, while the average GFR was 12.2 mL/min/1.73 m2. The overall mortality rate was 34%. Patients in the emergency department had the highest incidence (0.92%), while inpatients had the worst outcome (51% mortality). The leading cause of mortality was septic shock. The fatal group had higher rates of clinical symptoms, higher potassium values, CCS, and eGFR (all p<0.05).

Conclusions

Most of the responses for the reports were obtained within a short period of time. Patients with reported high critical serum potassium values were characterized by high rates of comorbidity, reduced eGFR, and mortality. The incidence, clinical manifestations, and outcomes varied in the different clinical settings.

Keywords: critical hyperkalemia; critical laboratory value; mortality; potassium
Corresponding author: Prof. Chien-Te Lee, Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung833, Taiwan, Phone: +886 7 7317123, Ext. 8306, Fax: +886 7 7322402, E-mail:

  1. Research funding: None declared.

  2. Author contributions: Chien-Te Lee and Wei-Hung Kuo: conceived and designed the study, analyzed the data, and wrote the first draft of the manuscript; Yueh-Ting Lee: analyzed the data and edited the manuscript; Huey-Ling You and Wan-Ting Huang: provided laboratory data and edited the manuscript; Terry Ting-Yu Chiou and Hwee-Yeong Ng: edited the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Ethical approval: The study was reviewed and approved by the Institutional Review Board of Chang Gung Memorial Hospital (201801819B0).

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-1476).

Received: 2020-10-05
Accepted: 2021-02-08
Published Online: 2021-02-22
Published in Print: 2021-06-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2020-1476
Keywords for this article
critical hyperkalemia; critical laboratory value; mortality; potassium

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Machine learning and coagulation testing: the next big thing in hemostasis investigations?
  4. Reviews
  5. Updates on liquid biopsy: current trends and future perspectives for clinical application in solid tumors
  6. The underestimated issue of non-reproducible cardiac troponin I and T results: case series and systematic review of the literature
  7. Opinion Paper
  8. Benefits, limitations and controversies on patient-based real-time quality control (PBRTQC) and the evidence behind the practice
  9. Genetics and Molecular Diagnostics
  10. ctDNA from body fluids is an adequate source for EGFR biomarker testing in advanced lung adenocarcinoma
  11. General Clinical Chemistry and Laboratory Medicine
  12. Incidence, characteristics and outcomes among inpatient, outpatient and emergency department with reported high critical serum potassium values
  13. Clinical usefulness of drug-laboratory test interaction alerts: a multicentre survey
  14. Integrating quality assurance in autoimmunity: the changing face of the automated ANA IIF test
  15. Plasma thiol/disulphide homeostasis changes in patients with restless legs syndrome
  16. Reference Values and Biological Variations
  17. High-resolution pediatric reference intervals for 15 biochemical analytes described using fractional polynomials
  18. Continuous reference intervals for leukocyte telomere length in children: the method matters
  19. Hematology and Coagulation
  20. Using machine learning to identify clotted specimens in coagulation testing
  21. Cardiovascular Diseases
  22. Long term pronostic value of suPAR in chronic heart failure: reclassification of patients with low MAGGIC score
  23. Infectious Diseases
  24. Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units
  25. A low level of CD16pos monocytes in SARS-CoV-2 infected patients is a marker of severity
  26. Thrombin generation in patients with COVID-19 with and without thromboprophylaxis
  27. Corrigendum
  28. Applying the concept of uncertainty to the sFlt-1/PlGF cut-offs for diagnosis and prognosis of preeclampsia
  29. Letters to the Editors
  30. Additional approaches for identifying non-reproducible cardiac troponin results
  31. Paediatric reference intervals for ionised calcium – a data mining approach
  32. A case of interference in testosterone, DHEA-S and progesterone measurements by second generation immunoassays
  33. Lack of cross-reactivity between anti-A IgG isoagglutinins and anti-SARS-CoV-2 IgG antibodies
  34. Artefactual bands on urine protein immunofixation gels
  35. A case of methaemoglobinaemia interference on the WDF channel on Sysmex XN-Series analysers
  36. Soluble fms-like tyrosine kinase-1: a potential early predictor of respiratory failure in COVID-19 patients
  37. Serendipitous detection of α1-antitrypsin deficiency: a single institution’s experience over a 32 month period
  38. The activated partial thromboplastin time may not reveal even severe fibrinogen deficiency
  39. Influence of C-reactive protein on thrombin generation assay
  40. Inappropriate extrapolations abound in fecal microbiota research
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