Mapping the role of pH‐adjusted potassium in diabetic ketoacidosis: Hypokalemia and the patient outcomes
| Autor: | Atif Usman, Juman Abdulelah Dujaili, Mohd Farooq Shaikh, Zobaer Hasan, Saleem Perwaiz Iqbal, Norlaila Mustafa, Siew Hua Gan |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty endocrine system diseases Diabetic ketoacidosis Potassium chemistry.chemical_element Hypokalemia 030204 cardiovascular system & hematology urologic and male genital diseases Diabetic Ketoacidosis 03 medical and health sciences Pharmacoeconomics 0302 clinical medicine Internal medicine medicine Humans Insulin 030212 general & internal medicine Early discharge Retrospective Studies business.industry Incidence (epidemiology) Acute kidney injury nutritional and metabolic diseases General Medicine Emergency department Hydrogen-Ion Concentration medicine.disease chemistry medicine.symptom business |
| Popis: | BACKGROUND Incidence of hypokalemia during the management of diabetic ketoacidosis (DKA) is high despite detailed potassium replacement guidelines in its treatment. AIM We aimed to find the role of pH-adjusted potassium (pHK ) in the development of hypokalemia, and their mutual impact on patient outcomes during DKA management. METHODOLOGY Adult DKA patient's admission data of preceding 3 years (2015-2017) were retrospectively clerked. Outcomes of interest were time to develop hypokalemia and to terminate emergency department (ED) care (hours), severity of hypokalemia and hospitalisation length (days). Linear regression was used to determine significant associations/predictors. RESULTS The study was concluded on 85 patients. Hypokalemia was observed in nearly 3/4th of all admissions and occurred by the time of ED care termination. Each 1 mmol/L increase in pHK significantly (a) reduced the degree of hypokalemia by 0.07 mmol/L, (b) delayed time to develop hypokalemia by 4.58 hours, (c) and reduced the ED care time by 1.28 hours. Arterial pH was the other factor significantly delaying time to develop hypokalemia (36.25 hours) and facilitating early discharge from ED (13.86 hours). Moreover, each 1 mmol/L reduction in the degree of hypokalemia increased hospitalisation length by 1.86 days. Though significant, acute kidney injury negligibly increased hospitalisation length by 0.01 days. CONCLUSION pH-adjusted potassium shall be used as a marker for hypokalemia and to initiate potassium replacement instead of measured serum potassium in DKA. Utilising pHK will help to avoid hypokalemia, reduce its severity and shorten ED care which will subsequently reduce hospitalisation length. We expect pHK to improve pharmacoeconomics in the future. |
| Databáze: | OpenAIRE |
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