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The role of renal potassium excretion in serum potassium derangements in two different patient groups

(2016) Jongejan, J. (Johanneke)

Background
Potassium derangements are associated with increased mortality at the intensive care unit
(ICU). This study hypothesizes that increased renal loss of potassium plays a role in the
development of potassium derangements in patients with traumatic brain injury who received
thiopental to induce barbiturate coma (Study A) and in patients who were cooled to
therapeutic hypothermia (TH, 33°C) or therapeutic normothermia (TN, 36°C) following an
out-of-hospital cardiac arrest (OHCA) (Study B).
Methods
A single-centre retrospective study was performed. Serum potassium levels were used to
determine the incidence of potassium derangements. Potassium balances were calculated from
potassium intake and potassium excretion. In Study A three phases were compared; before,
during and after thiopental infusion. In Study B the hypothermia/normothermia phase
(HT/NT phase) consisted of two calendar days after admission. The post-HT/NT phase
consisted of two calendar days following cessation of the HT/NT phase.
Results
Five patients were included in Study A and 34 patients in Study B (n=16 for TH, n=18 for
TN). In Study A, the incidence of hypokalemia was higher during thiopental infusion
compared to before and after therapy, respectively, 100%, 60% and 25% (P=0.03). There
were no significant differences between potassium balances during thiopental therapy
compared to before and after therapy. In Study B, median cumulative potassium
administration during the HT/NT phase was 112 (IQR, 65 to 142) mmol in the TH group
compared to 36 (IQR, 25 to 54) mmol in the TN group (P<0.001), which resulted in median
serum potassium levels of, respectively, 4.2 (IQR, 3.9 to 4.6) mmol/L and 4.0 (IQR, 3.8 to
4.3) mmol/L (P<0.001). Hyperkalemia was more common in the TH group than in the TN
group, respectively, in 63% and 11% of patients (P=0.003). There was no difference in
median potassium balances between the TH group and the TN group (P=0.145).
Conclusion
In our study increased renal loss of potassium did not play an evident role in the development
of hypokalemia during thiopental infusion and during hypothermia. Since hypokalemia was
common during thiopental infusion whereas hyperkalemia was common during and after
cooling in the TH group, potassium should be monitored regularly in order to be able to adjust
potassium administration. An additional study with increased sample size is necessary to
determine the exact role of renal potassium loss in patients who received a barbiturate coma
or were cooled to hypothermia/normothermia after hospital admission with an OHCA.





ID 3390
Moeder ID 3084
Volgorde Jongejan, J.
Naam JongejanJ
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2016/JongejanJ/
Gemaakt op: 2017-04-12 11:26:34
Gemodificeerd op: 2017-04-12 11:26:34
Digitaal ID 58ee0eeba4d7d
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel The role of renal potassium excretion in serum potassium derangements in two different patient groups
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 21
Publicatiejaar 2016
Taal en
Engelse samenvatting Background
Potassium derangements are associated with increased mortality at the intensive care unit
(ICU). This study hypothesizes that increased renal loss of potassium plays a role in the
development of potassium derangements in patients with traumatic brain injury who received
thiopental to induce barbiturate coma (Study A) and in patients who were cooled to
therapeutic hypothermia (TH, 33°C) or therapeutic normothermia (TN, 36°C) following an
out-of-hospital cardiac arrest (OHCA) (Study B).
Methods
A single-centre retrospective study was performed. Serum potassium levels were used to
determine the incidence of potassium derangements. Potassium balances were calculated from
potassium intake and potassium excretion. In Study A three phases were compared; before,
during and after thiopental infusion. In Study B the hypothermia/normothermia phase
(HT/NT phase) consisted of two calendar days after admission. The post-HT/NT phase
consisted of two calendar days following cessation of the HT/NT phase.
Results
Five patients were included in Study A and 34 patients in Study B (n=16 for TH, n=18 for
TN). In Study A, the incidence of hypokalemia was higher during thiopental infusion
compared to before and after therapy, respectively, 100%, 60% and 25% (P=0.03). There
were no significant differences between potassium balances during thiopental therapy
compared to before and after therapy. In Study B, median cumulative potassium
administration during the HT/NT phase was 112 (IQR, 65 to 142) mmol in the TH group
compared to 36 (IQR, 25 to 54) mmol in the TN group (P<0.001), which resulted in median
serum potassium levels of, respectively, 4.2 (IQR, 3.9 to 4.6) mmol/L and 4.0 (IQR, 3.8 to
4.3) mmol/L (P<0.001). Hyperkalemia was more common in the TH group than in the TN
group, respectively, in 63% and 11% of patients (P=0.003). There was no difference in
median potassium balances between the TH group and the TN group (P=0.145).
Conclusion
In our study increased renal loss of potassium did not play an evident role in the development
of hypokalemia during thiopental infusion and during hypothermia. Since hypokalemia was
common during thiopental infusion whereas hyperkalemia was common during and after
cooling in the TH group, potassium should be monitored regularly in order to be able to adjust
potassium administration. An additional study with increased sample size is necessary to
determine the exact role of renal potassium loss in patients who received a barbiturate coma
or were cooled to hypothermia/normothermia after hospital admission with an OHCA.
Nederlandse samenvatting Achtergrond
Hypokaliëmia en hyperkaliëmie zijn geassocieerd met een hogere mortaliteit op de intensive
care (IC). Deze studie onderzoekt of toegenomen renaal verlies van kalium een rol speelt bij
de ontwikkeling van afwijkende kaliumwaarden bij patiënten met traumatisch hersenletsel die
zijn behandeld met thiopental (Studie A) en bij patiënten die zijn gekoeld tot 33°C
(therapeutische hypothermie, TH) of 36°C (therapeutische normothermie, TN) na een out-ofhospital
cardiac arrest (OHCA)(Studie B).
Methode
In deze retrospectieve studie werden serum kaliumwaarden gebruikt om de incidentie van
hypo-en hyperkaliëmia te bepalen. Kaliumbalansen werden berekend door middel van kalium
intake en renale kalium output. In Studie A werden drie fasen vergeleken; voor, tijdens en na
thiopental infusie. In Studie B werden tussen beide groepen twee fasen vergeleken. De eerste
twee kalenderdagen na opname in het ziekenhuis met OHCA werden aangeduid als de
hypothermie/normothermie fase (HT/NT fase). De post-HT/NT fase bestond uit twee
kalenderdagen na afloop van de HT/NT fase.
Resultaten
In Studie A werden vijf patiënten geanalyseerd, in Studie B werden 34 patiënten geïncludeerd
(TH;n=16,TN;n=18). De incidentie van hypokaliëmie was hoger gedurende thiopental infusie
(100%), dan voor (60%) en na (25%) therapie (P=0.03). Er was geen significant verschil in de
gemiddelde kaliumbalans tijdens thiopental infusie vergeleken met voor en na therapie. In
Studie B, mediane cumulatieve kalium suppletie tijdens de HT/NT fase was 112 (IQR, 65 to
142) mmol in de TH groep vergeleken met 36 (IQR, 25 to 54) mmol in de TN groep
(P<0.001). Mediane serum kaliumwaarden waren, respectievelijk, 4.2 (IQR, 3.9 to 4.6)
mmol/L en 4.0 (IQR, 3.8 to 4.3) mmol/L (P<0.001). Hyperkaliëmie kwam vaker voor in de
TH groep dan in de TN groep, in 63% en 11% van de patiënten (P=0.003). Er was geen
verschil in mediane cumulatieve kaliumbalansen tussen de TH groep en de TN groep
(P=0.145).
Conclusie
Toegenomen renaal verlies van kalium speelde in deze studie geen rol in de ontwikkeling van
hypokaliëmie gedurende thiopental coma en gedurende hypothermie. Omdat hypokaliëmie
vaak voorkomt tijdens thiopental infusie en hyperkaliëmia vaker voorkomt gedurende
hypothermie is het aan te bevelen serum kaliumwaarden regelmatig te meten om kalium
suppletie adequaat aan te kunnen passen. Een additionele studie met een grotere
steekproefomvang is nodig om de exacte rol van renaal kaliumverlies te bepalen in de
ontwikkeling van hypo-en hyperkaliëmie bij patiënten die zijn behandeld met thiopental en
bij patiënten die gekoeld zijn tot hypothermie of normothermie na een OHCA.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Jongejan, J. (Johanneke)
UMCG begeleider(s) Faculty mentor; Nijsten, M.W.; Additional mentor; Hessels, L. MD/PhD Student; Location Department of Critical Care, University Medical Cen
Auteur(s) Jongejan, J. (Johanneke)
UMCG begeleider(s) Faculty mentor; Nijsten, M.W.; Additional mentor; Hessels, L. MD, PhD Student; Location Department of Critical Care, University Medical Cen


 
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