Severe bradycardia from severe hyperkalemia: Patient characteristics, outcomes and factors associated with hemodynamic support.
Am J Emerg Med
; 55: 117-125, 2022 05.
Article
em En
| MEDLINE
| ID: mdl-35306438
ABSTRACT
OBJECTIVE:
Bradycardia is an under-studied manifestation of hyperkalemia potentially associated with adverse outcomes. We sought to systematically describe emergency department (ED) patients that present with severe bradycardia (heart rate < 50) associated with severe hyperkalemia (potassium ≥6.0 mEQ/L) and identify factors associated with the receipt of hemodynamic support.METHODS:
Retrospective, single-center, case series performed at an urban, tertiary-care hospital from 1/1/2014 to 6/30/2020. We included consecutive adult ED patients presenting simultaneously with severe bradycardia and severe hyperkalemia. Patients with prehospital cardiac arrest, hemolyzed potassium specimens, or only point-of-care lab results were excluded. Detailed information, including chronic medications, electrocardiogram (ECG) features, and potassium/heart rate-directed treatments, was abstracted from the ED medical record. Intensive care utilization and in-hospital outcomes were also recorded. Factors associated with receipt of bradycardia-targeted treatment in the ED were determined with univariate comparisons.RESULTS:
We screened 319 records and included 87 patients [mean age 72.5 (95% CI 53-92), 55% female, median heart rate 43 (38-47) beats/min, mean potassium 7.1 (95% CI 5.6-8.7) mEQ/L]. Cardiovascular (hypertension 82%, congestive heart failure 28%) and renal (dialysis dependence 30%) comorbidities were common. Many patients were prescribed negative chronotropic agents (84%) or potassium-retaining (52%) chronic medications. Common presenting scenarios were missed hemodialysis, isolated acute renal failure, or acute renal failure in the setting of concomitant critical illness. ECG revealed junctional rhythm (39%), peaked T waves (27%), and QRS prolongation (30%). Twenty-eight (32%) patients exhibited hypotension and 34 (40%) altered mentation. Thirty-three (38%) patients received hemodynamic support, including 12 (14%) requiring temporary cardiac pacing. Forty-two (48%) patients received emergent renal replacement therapy and 57 (66%) were admitted to the intensive care unit. Hospital mortality was 10%. Factors associated with receipt of hemodynamic-targeted treatment included a lack of dialysis dependence, junctional rhythm, and concomitant presentation with hypothermia, acidemia, or sepsis.CONCLUSIONS:
Patients presenting with severe bradycardia represent a unique phenotype of ED patients with hyperkalemia that may require significant resuscitation and critical care resources. Further research on the treatment of this uncommon, but potentially life-threatening condition is needed.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Injúria Renal Aguda
/
Hiperpotassemia
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
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Humans
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Male
Idioma:
En
Revista:
Am J Emerg Med
Ano de publicação:
2022
Tipo de documento:
Article