In this episode, I’ll discuss hyper and hypokalemia thresholds that are associated with in-hospital cardiac arrest.
Both hyperkalemia and hypokalemia are potentially reversible causes of cardiac arrest. A group of authors published a registry-based matched case-control study in the journal Critical Care Medicine to determine how the risk of in-hospital cardiac arrest changes relative to the severity of hyperkalemia and hypokalemia.
The study drew from a Danish in-hospital cardiac arrest registry and analyzed over 6500 cases matched with nearly 50,000 controls. The exposure was considered potassium levels within 24 hours of the time of cardiac arrest. Outcomes were in-hospital cardiac arrest and return of spontaneous circulation, 30-day survival, and 1-year survival in those with cardiac arrest.
Hyperkalemia above 6.5 mEq/L and hypokalemia below 2.5 were significantly associated with 2.03 and 2.65 times the odds of in-hospital cardiac arrest compared with normokalemia, respectively.
Only hyperkalemia was associated with decreased odds of return of spontaneous circulation, 30-day survival, and 1-year survival after in-hospital cardiac arrest as the severity of the hyperkalemia increased; there was no such association with increasing severity of hypokalemia.
The authors concluded:
Hyperkalemia was associated with an increased risk of in-hospital cardiac arrest and with worse outcomes after cardiac arrest. Hypokalemia was associated with an increased risk of in-hospital cardiac arrest but was not associated with outcomes after cardiac arrest.
Pharmacists can use this information to help identify patients at elevated risk of in-hospital cardiac arrest and perhaps establish quality metrics for electrolyte replacement protocols to ensure potassium levels assocaited with in-hospital cardiac arrest are not reached.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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