title: Life-threatening drug-associated hyperkalemia: a retrospective study from laboratory signals.
abstract: OBJECTIVE
  Life-threatening hyperkalemia may be induced by drugs and preventable in at-risk patients. This study was designed to describe cases of 'serious' drug-associated hyperkalemia.
  
  
  METHODS
  Adult subjects with a serum potassium concentration above 6.5 mmol/L detected at admission or during hospital stay in nephrology, cardiology, geriatric, emergency or intensive care units were identified by biology laboratories of hospitals and clinics located in Midi-Pyrenees (southwest France). Patients dialyzed for end-stage kidney disease were excluded. Data were collected from medical files. Hyperkalemia was defined as drug-associated if at least one drug known to increase serum potassium concentration was taken when hyperkalemia occurred (among drugs taken in outpatient care for hyperkalemia detected at admission and among drugs taken in outpatient care and continued at hospital and drugs introduced from admission for hyperkalemia detected during hospital stay).
  
  
  RESULTS
  Of 168 hyperkalemia cases, 102 (60.7%) were classified as drug-associated. They concerned elderly patients (mean age: 76.1 years) often having arterial hypertension and/or cardiac diseases (88.2%). Risk factors, mainly acute kidney failure, were observed in almost all cases (98.0%). Drugs predominantly involved were angiotensin-converting enzyme inhibitors (47.1%), spironolactone (41.2%), angiotensin II receptor antagonists (23.5%) and potassium supplements (23.5%). In 10% of cases, death could be attributed to hyperkalemia.
  
  
  CONCLUSIONS
  Laboratory databases allowed an exhaustive identification of hyperkalemia cases. The frequency of drug-related hyperkalemia and their characteristics suggest that treatment with drugs known to increase serum potassium concentration can be inappropriate, especially regarding associations or indications, and is highly risky for predisposed patients.
authors: CHU de Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, F-31000 Toulouse, France.
authors: Pernelle
authors: P
authors: Noize
authors: Haleh
authors: H
authors: Bagheri
authors: Geneviève
authors: G
authors: Durrieu
authors: Françoise
authors: F
authors: Haramburu
authors: Nicholas
authors: N
authors: Moore
authors: Patrick
authors: P
authors: Giraud
authors: Michel
authors: M
authors: Galinier
authors: Jacques
authors: J
authors: Pourrat
authors: Jean-Louis
authors: JL
authors: Montastruc
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005602:France; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D011188:Potassium / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D004364:Pharmaceutical Preparations; D011188:Potassium