#3145 Severe hyperkalaemia: a retrospective study of clinical characteristics, aetiology, and management

Field: Medicine (Health Sciences)

Abstract Background and Aims Hyperkalaemia is common electrolyte abnormality in hospitalised patients with a prevalence of 1.1–10%. It is a life-threatening emergency, often asymptomatic until cardiac arrest, making early recognition and treatment critical. The primary aim of this study was to examine the risk factors for developing hyperkalaemia and to examine whether serum potassium was managed and reduced below 6.0 mmol/L in a timely manner. Method A retrospective study was performed of all patients with severe hyperkalaemia (HK) defined as a serum potassium &gt;/= 6.0 mmol/L over a 6-month period across 2023 & 2024. Patients on haemodialysis, outpatient clinic and external hospital samples and haemolysed samples were excluded. Those patients included in further analysis were Emergency Department and inpatients where there is an expectation of prompt treatment of serious hyperkalaemia. Demographic, clinical and laboratory data were reviewed. EGFR was calculated using the MDRD equation. Frequency of monitoring of serum potassium levels and time to achieving serum potassium &lt; 6.0 mmol/L was recorded. Results In total, there were over 300 cases of severe HK of which 126 patients met the inclusion criteria. The median serum K was 6.2 mmol/L (Range 6.0–8.2 mmol/L): 73.8% (n = 93) had serum K between 6.0–6.4 mmol/L with 4.8% (n = 6) of patients having a serum K &gt;/= 7.0 mmol/L. The median age was 71 years (Range 20–91 years), 65.9% (n = 83) of whom were male. The commonest reasons for admission were sepsis (34.1%), active malignancy (19.0%), decompensated congestive cardiac failure (5.6%) and elective cardiac surgery (5.6%). All patients had at-least one co-morbidity pre-admission, the commonest of which were CKD (52.38%), diabetes mellitus (52.4%) and congestive cardiac failure (27.0%). Renal dysfunction was common in this group with 54.8% (n = 69) had an eGFR &lt; 60 mls/min/1.73 m2 while 37.3% (n = 47) had acute kidney injury at the time of diagnosis of severe hyperkalaemia. Additional diagnostic tests that aid the diagnosis and management of hyperkalaemia were performed in less than 50% of cases including measure of pH (44%), Glucose (44.5%) and creatinine kinase (CK) (23%). In those where this data was recorded the median values were pH 7.321 (range 7.04–7.512), glucose 7.55 mmol/L (range 4.2–54.0 mmol/L) and CK 135 iu/L (range 14–13,659 iu/L). The median time taken to achieve a serum K &lt; 6.0 mmol/L was 6 hours (range 1–107 hours): serum K &lt; 6.0 mmol/L was achieved within 2 hours in 30.2% (n = 38) of cases, within 6 hours in 32.6% (n = 41) and within 24 hours in 22.1% (n = 28). The remaining 15.1% (n = 19) remained hyperkaliaemic for greater than 24 hours. Risk factors for prolonged HK included known chronic kidney disease, diabetes mellitus (both insulin requiring and non-insulin requiring), tumour lysis syndrome in the setting of active malignancy and sepsis. Prolonged severe hyperkalaemia was not influenced by age, gender, severity of hyperkalaemia at time of diagnosis or the presence of congestive cardiac failure. Conclusion Severe HK is a clinical condition that is commonly seen in hospitalised patients, in particular with sepsis and active malignancy. Timely recognition and management is crucial to prevent adverse outcomes and further research is warranted to refine correction protocols and improve outcomes.