High levels of potassium in the blood, common in people on certain medications or with kidney disease, often come with no symptoms, but can be deadly in severe cases.
Because people with hyperkalemia, or high potassium, often "feel normal," their treating physicians must determine whether their condition can be safely managed outside the hospital or requires more urgent treatment in the emergency department.
Researchers at Western University and London Health Sciences Centre Research Institute (LHSCRI) have shown that the risk of death was significantly lower among patients who were able to get to an emergency department within 24 hours of an abnormally high potassium reading. The study was recently published in the Canadian Medical Association Journal.
"The challenge is patients with hyperkalemia can feel completely fine, even when their potassium is at a dangerously high level. It can be difficult for patients to understand why they need to get to the emergency department right away," said Dr. Michael Chiu, professor at Western's Schulich School of Medicine & Dentistry and scientist at LHSCRI.
What's the role of potassium?
Potassium is a normal electrolyte found in the body, but for people with certain kidney conditions or on some blood pressure medications, the body's ability to flush the potassium is impaired, leading to a build-up in the blood. Because potassium is a key player in the electrical activity of the heart, elevated levels can trigger abnormal heart rhythms and potentially fatal cardiac arrest.
Using population health data from the Institute for Clinical Evaluative Sciences, the researchers explored patients who weren't already admitted to hospital to determine how many went to the emergency department and how that correlated with their risk of dying.
"It was the first study to investigate if patients with diagnosed high potassium were going to the emergency department or not, and for those who went, what their outcomes were," said Chiu. "When people are admitted to hospital or seen in the emergency department, there are medications we can give that help protect the heart. There are also intravenous medications that can lower potassium levels quickly by moving it into cells or helping remove it from the body. These emergency treatments can only be done in a hospital setting."
The team hopes to use this as a starting point to develop a clinical decision-making tool for health-care providers to consider patient characteristics like age and other chronic conditions, as well as laboratory values, when managing patients with a high outpatient potassium value and making a determination about whether or not they need in-hospital care.
"One of the reasons we wanted to do this research is that if we get a call in the middle of the night from a lab saying a patient has high potassium, we have to decide whether the patient needs to go to the emergency department and convince the patient why it is important to do so," he said. "We also need to ensure that patients who may not benefit from in-hospital treatment, aren't making an unnecessary trip to the emergency department."
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