title: Management of hyperkalemia in hospitalized patients.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence of treatment of hyperkalemia in hospitalized patients.
  
  
  METHODS
  This is a prospective chart review of adults in a tertiary care hospital with hyperkalemia (serum potassium [K] ≥5.1 mEq/L) over a 6-month period. The treatments and their effectiveness, causative factors and associated electrocardiographic (ECG) changes were examined.
  
  
  RESULTS
  There were 154 hyperkalemic episodes, 32 with K ≥6.5 mEq/L and 122 with K<6.5 mEq/L. Overall, 97% received treatment for an average K of 5.9 mEq/L. Sodium polystyrene sulfonate (SPS) was included in 95% of the regimens. Incremental doses of SPS monotherapy yielded potassium reductions between 0.7 and 1.1 mEq/L, and inadequate responses (K <0.5 mEq/L) were less frequent with higher doses. There were no differences in the effectiveness of SPS among dialysis-dependent, chronic kidney disease, or nonchronic kidney disease patients. Greater reductions in potassium were observed using a combination of treatments. ECGs were performed in 44% of patients, and 50% showed no ECG changes despite K being ≥6.5 mEq/L. The most common abnormality, peaked T waves, was associated with a higher frequency of calcium administration but not with the number of K+-lowering therapies.
  
  
  CONCLUSIONS
  Almost all the patients were treated for hyperkalemia. Oral SPS monotherapy was the predominant treatment with the best response at the highest dose. Some combination therapies had greater K reductions but were used infrequently. An ECG was obtained in about 50% of the cases, but two thirds showed no K-related changes. Reduced kidney function was associated with 70% of hyperkalemic episodes. Angiotensin-converting enzyme inhibitors and trimethoprim were the most commonly implicated medications.
authors.affiliation: Department of Pharmaceutical Services (KNF), Emory University Hospital Midtown, Atlanta, Georgia; Department of Pharmacy and Drug Information (TW), Grady Health System, Atlanta, Georgia; and Renal Division (JJD), Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia.
authors.forename: Kristy N
authors.initials: KN
authors.lastname: Fordjour
authors.forename: Ted
authors.initials: T
authors.lastname: Walton
authors.forename: John J
authors.initials: JJ
authors.lastname: Doran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage / Q000627:therapeutic use; D002411:Cation Exchange Resins / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy* / Q000209:etiology; D007328:Insulin / Q000627:therapeutic use; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011137:Polystyrenes / Q000008:administration & dosage / Q000627:therapeutic use*; D006435:Renal Dialysis; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D002411:Cation Exchange Resins; D007328:Insulin; D011137:Polystyrenes; C003321:polystyrene sulfonic acid; D017693:Sodium Bicarbonate; D000420:Albuterol; D002118:Calcium