{"pk":10428,"title":"Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?","subtitle":null,"abstract":"Introduction: \nThe electrocardiogram (ECG) is often used to identify which hyperkalemic patients are atrisk for adverse events. However, there is a paucity of evidence to support this practice. This studyanalyzes the association between specific hyperkalemic ECG abnormalities and the development ofshort-term adverse events in patients with severe hyperkalemia.\nMethods:\n We collected records of all adult patients with potassium (K+) ≥6.5 mEq/L in the hospitallaboratory database from August 15, 2010, through January 30, 2015. A chart review identified patientdemographics, concurrent laboratory values, ECG within one hour of K+ measurement, treatments andoccurrence of adverse events within six hours of ECG. We defined adverse events as symptomaticbradycardia, ventricular tachycardia, ventricular fibrillation, cardiopulmonary resuscitation (CPR) and/ordeath. Two emergency physicians blinded to study objective independently examined each ECG forrate, rhythm, peaked T wave, PR interval duration and QRS complex duration. Relative risk wascalculated to determine the association between specific hyperkalemic ECG abnormalities and shorttermadverse events.\nResults:\n We included a total of 188 patients with severe hyperkalemia in the final study group. Adverseevents occurred within six hours in 28 patients (15%): symptomatic bradycardia (n=22), death (n=4),ventricular tachycardia (n=2) and CPR (n=2). All adverse events occurred prior to treatment with calciumand all but one occurred prior to K+-lowering intervention. All patients who had a short-term adverse eventhad a preceding ECG that demonstrated at least one hyperkalemic abnormality (100%, 95% confidenceinterval [CI] [85.7-100%]). An increased likelihood of short-term adverse event was found forhyperkalemic patients whose ECG demonstrated QRS prolongation (relative risk [RR] 4.74, 95% CI[2.01-11.15]), bradycardia (HR<50) (RR 12.29, 95%CI [6.69-22.57]), and/or junctional rhythm (RR 7.46,95%CI 5.28-11.13). There was no statistically significant correlation between peaked T waves andshort-term adverse events (RR 0.77, 95% CI [0.35-1.70]).\nConclusion:\n Our findings support the use of the ECG to risk stratify patients with severehyperkalemia for short-term adverse events. [West J Emerg Med. 2017;18(5)963-971.]","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"arrhythmias"},{"word":"Cardiac"},{"word":"ECG"},{"word":"QRS prolongation"},{"word":"bradycardia"},{"word":"T wave peaked"},{"word":"Renal Insufficiency"},{"word":"chronic kidney disease"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7623h6zc","frozenauthors":[{"first_name":"Nicole","middle_name":"","last_name":"Durfey","name_suffix":"","institution":"Kent Hospital, Department of Emergency Medicine, Warwick, Rhode Island","department":"None"},{"first_name":"Brian","middle_name":"","last_name":"Lehnhof","name_suffix":"","institution":"Kent Hospital, Department of Emergency Medicine, Warwick, Rhode Island","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"Bergeson","name_suffix":"","institution":"Kent Hospital, Department of Emergency Medicine, Warwick, Rhode Island","department":"None"},{"first_name":"Shayla","middle_name":"N.M.","last_name":"Durfey","name_suffix":"","institution":"The Warren Alpert Medical School of Brown University, Providence, Rhode Island","department":"None"},{"first_name":"Victoria","middle_name":"","last_name":"Leytin","name_suffix":"","institution":"The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island","department":"None"},{"first_name":"Kristina","middle_name":"","last_name":"McAteer","name_suffix":"","institution":"The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island","department":"None"},{"first_name":"Eric","middle_name":"","last_name":"Schwam","name_suffix":"","institution":"The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island","department":"None"},{"first_name":"Justin","middle_name":"","last_name":"Valiquet","name_suffix":"","institution":"Kent Hospital, Department of Emergency Medicine, Warwick, Rhode Island","department":"None"}],"date_submitted":"2016-10-31T17:33:37Z","date_accepted":"2016-10-31T17:33:37Z","date_published":"2017-07-10T21:32:34Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/10428/galley/5734/download/"}]}