Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): A Multicenter, Prospective, Observational Study.
J Emerg Med
; 55(6): 741-750, 2018 Dec.
Article
em En
| MEDLINE
| ID: mdl-30391144
ABSTRACT
BACKGROUND:
Contemporary emergency department (ED) standard-of-care treatment of hyperkalemia is poorly described.OBJECTIVE:
Our aim was to determine the treatment patterns of hyperkalemia management in the ED.METHODS:
This multicenter, prospective, observational study evaluated patients aged ≥ 18 years with hyperkalemia (potassium [K+] level ≥ 5.5 mmol/L) in the ED from October 25, 2015 to March 30, 2016. K+-lowering therapies and K+ were documented at 0.5, 1, 2, and 4 h after initial ED treatment. The primary end point was change in K+ over 4 h.RESULTS:
Overall, 203 patients were enrolled at 14 U.S.-based sites. The initial median K+ was 6.3 (interquartile range [IQR] 5.7-6.8) mmol/L and median time to treatment was 2.7 (IQR 1.9-3.5) h post-ED arrival. Insulin/glucose (n = 130; 64%) was frequently used to treat hyperkalemia; overall, 43 different treatment combinations were employed within the first 4 h. Within 4 h, the median K+ for patients treated with medications alone decreased from 6.3 (IQR, 5.8-6.8) mmol/L to 5.3 (4.8-5.7) mmol/L, while that for patients treated with dialysis decreased from 6.2 (IQR 6.0-6.6) mmol/L to 3.8 (IQR 3.6-4.2) mmol/L. Hypoglycemia occurred in 6% of patients overall and in 17% of patients with K+ > 7.0 mmol/L. Hyperkalemia-related electrocardiogram changes were observed in 23% of all patients; 45% of patients with K+ > 7.0 mmol/L had peaked T waves or widened QRS. Overall, 79% were hospitalized; 3 patients died.CONCLUSIONS:
Hyperkalemia practice patterns vary considerably and, although treatment effectively lowered K+, only dialysis normalized median K+ within 4 h.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Serviço Hospitalar de Emergência
/
Hiperpotassemia
Tipo de estudo:
Clinical_trials
/
Observational_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Emerg Med
Assunto da revista:
MEDICINA DE EMERGENCIA
Ano de publicação:
2018
Tipo de documento:
Article