PURPOSE: Disorders of potassium homeostasis are the most common electrolyte abnormalities encountered in hospitalized patients, with hypokalemia found in more than 20 percent.When compared to the normokalemic population, the hypokalemic population had a higher mortality rate and was more likely to stay longer in the ICU.Electrolyte repletion protocols in the ICU were modified at our institution in 2006-07. The modifications were made after reviewing and comparing protocols of other academic institutions.There is limited information regarding the efficacy of electrolyte replacement protocols.
METHODS: METHODS:The study was performed as a retrospective observational review of all patients admitted to the 32-bed adult ICU at Cooper university hospital from Jan 1st,2009 to Feb 28th, 2009. Patients were identified via the Project IMPACT database.Serum potassium values were recorded both on Day 1 and Day 5 (or last day if discharged earlier)of ICU admission. Hypokalemic patients were divided in groups according to potassium level, i.e. extremely low (<2.5), low (2.6-3.0), low normal (3.1-3.5), normal (3.6-4.5), high (>4.6).The number of subjects in each group was calculated and their trend followed on day 5 or last day in ICU. They were subsequently divided into three subgroups, i.e. those in whom K range remains same comprise first group, those in whom hypokalemia improves to normal comprise the second group and those in whom hypokalemia persists or worsens comprise the third group.
RESULTS: RESULTS:Only 32% of patients with hypokalemia improved their potassium to normal level while 68 % did not improve which was significant at p value of <0.001 on binomial test.The institution of electrolyte repletion protocol was expected to correct potassium in a majority (99%)of patients.
CONCLUSION: CONCLUSIONS:Our study shows that the current Electrolyte repletion protocol implemented at various academic hospital ICUs does not sufficiently correct potassium in critically ill patients.
CLINICAL IMPLICATIONS: CLINICAL IMPLICATIONS:The increase in mortality associated with hypokalemia in ICU is already established. Therefore, the electrolyte protocol needs to be altered in order to make it more effective in correcting hypokalemia.
DISCLOSURE: Jehanzeb Bilal, No Financial Disclosure Information; No Product/Research Disclosure Information