title: Hypokalaemia and subsequent hyperkalaemia in hospitalized patients.
abstract: BACKGROUND
  The objective was to study the epidemiology of hypokalaemia [serum potassium concentration (S(K)) <3.5 mmol/l] in a general hospital population, specifically focusing on how often and why patients develop subsequent hyperkalaemia (S(K) > or =5.0 mmol/l).
  
  
  METHODS
  In a 3-month hospital-wide study we analysed factors contributing to hypokalaemia and subsequent hyperkalaemia.
  
  
  RESULTS
  From 1178 patients in whom S(K) was measured, 140 patients (12%) with hypokalaemia were identified (S(K) 3.0 +/- 0.3 mmol/l). One hundred patients (71%) had hospital-acquired hypokalaemia. Common causes of hypokalaemia included gastrointestinal losses (67%), diuretics (36%) and haematological malignancies (9%). In 104 patients (74%), hypokalaemia was multifactorial. Hypokalaemia frequently coexisted with hyponatraemia (24%) and, when measured, hypomagnesaemia (61%). Twenty-three patients (16%) developed hyperkalaemia (highest S(K) 5.7 +/- 0.7 mmol/l) following hypokalaemia. In these patients, potassium suppletion was not more common (70 vs 59%, P = 0.5), but when potassium was given, the total amount administered was significantly higher (median 350 mmol vs 180 mmol, P = 0.02). Furthermore, these patients more often received total parenteral nutrition (17 vs 4%, P = 0.02) and magnesium suppletion (30 vs 9%, P = 0.009), and more often had haematological malignancies (22 vs 6%, P = 0.03).
  
  
  CONCLUSIONS
  Hypokalaemia is a multifactorial and usually hospital-acquired condition associated with hyponatraemia and hypomagnesaemia. One out of every six patients with hypokalaemia developed subsequent hyperkalaemia. Besides potassium suppletion, total parenteral nutrition (source of potassium), magnesium suppletion (may reduce kaliuresis) and haematological malignancy (may cause cell lysis) contribute to hyperkalaemia following hypokalaemia. Caution with potassium suppletion and frequent monitoring of S(K) may prevent iatrogenic hyperkalaemia.
authors.affiliation: Deprtment of Internal Medicine,Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Meindert J
authors.initials: MJ
authors.lastname: Crop
authors.forename: Ewout J
authors.initials: EJ
authors.lastname: Hoorn
authors.forename: Jan
authors.initials: J
authors.lastname: Lindemans
authors.forename: Robert
authors.initials: R
authors.lastname: Zietse
mesh_terms: D005260:Female; D006760:Hospitalization; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology*; D007008:Hypokalemia / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged