Quickly normalizing serum potassium levels in hyperkalemic patients visiting the emergency department (ED) might cut their death risk.

In a review of 114,977 ED visits to Stony Brook University hospital in New York during 2016 to 2017, 1033 patients (mean age 60 years; 58% male) presented with a serum potassium level of 5.5 mEq/L or higher. In-patient mortality (8.5% vs 0.8%) and hospital admission (80% vs 39%) rates were significantly higher in hyperkalemic than normokalemic patients, respectively, according to results published in the American Journal of Emergency Medicine.

In the hyperkalemia group, patients whose serum potassium level normalized to less than 5.5 mEq/L within 3 to 8 hours had a significantly lower death risk (6.3% vs 12.7%) than those whose serum potassium level remained persistently elevated, Adam J. Singer, MD, and colleagues reported. Normalization of potassium level were associated with a significant 53% lower mortality risk. The team accounted for patient age, comorbidities, serum creatinine, and initial potassium level. Hospital and intensive care unit admission rates and length of stay appeared similar between groups.

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Only 60% of patients presenting with hyperkalemia received treatment in the ED. Similar proportions of patients who did and did not experience potassium normalization received treatment. It is unclear why some patients were resistant to therapy.  

The authors stated that their study is the first showing that ED patients presenting with hyperkalemia have a lower mortality risk when their potassium levels normalize while still in the ED than when the levels remain elevated. “If prospectively confirmed, our findings will have implications for ED operations as to more rapidly identifying hyperkalemic patients (e.g., the more standard use of rapid point of care testing as a mortality reduction intervention), as well as suggesting the necessity of the immediate implementation of [potassium] lowering therapy,” Dr Singer and his coauthors suggested.  

Newer potassium binding agents were not evaluated in this study, which is a limitation. Additional evidence and guidelines on which, or how many, therapies are safe and effective are needed, the investigators highlighted.

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Singer AJ, Thode Jr HC, Peacock WF. Rapid correction of hyperkalemia is associated with reduced mortality in ED patients [published online December 10, 2019]. Am J Emerg Med. doi: 10.1016/j.ajem.2019.12.012