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Critical Care

, 16:R225

First Online: 21 November 2012Received: 15 July 2012Revised: 16 November 2012Accepted: 19 November 2012


IntroductionSevere hyperkalemia, with potassium K levels ≥ 6.5 mEq-L, is a potentially life-threatening electrolyte imbalance. For prompt and effective treatment, it is important to know its risk factors, clinical manifestations, and predictors of mortality.

MethodsAn observational cohort study was performed at 2 medical centers. A total of 923 consecutive Korean patients were analyzed. All were 19 years of age or older and were hospitalized with severe hyperkalemia between August 2007 and July 2010; the diagnosis of severe hyperkalemia was made either at the time of admission to the hospital or during the period of hospitalization. Demographic and baseline clinical characteristics at the time of hyperkalemia diagnosis were assessed, and clinical outcomes such as in-hospital mortality were reviewed, using the institutions- electronic medical record systems.

ResultsChronic kidney disease CKD was the most common underlying medical condition, and the most common precipitating factor of hyperkalemia was metabolic acidosis. Emergent admission was indicated in 68.6% of patients, 36.7% had electrocardiogram findings typical of hyperkalemia, 24.5% had multi-organ failure MOF at the time of hyperkalemia diagnosis, and 20.3% were diagnosed with severe hyperkalemia at the time of cardiac arrest. The in-hospital mortality rate was 30.7%; the rate was strongly correlated with the difference between serum K levels at admission and at their highest point, and with severe medical conditions such as malignancy, infection, and bleeding. Furthermore, a higher in-hospital mortality rate was significantly associated with the presence of cardiac arrest and-or MOF at the time of diagnosis, emergent admission, and intensive care unit treatment during hospitalization. More importantly, acute kidney injury AKI in patients with normal baseline renal function was a strong predictor of mortality, compared with AKI superimposed on CKD.

ConclusionsSevere hyperkalemia occurs in various medical conditions; the precipitating factors are similarly diverse. The mortality rate is especially high in patients with severe underlying disease, coexisting medical conditions, and those with normal baseline renal function.

AbbreviationsAKIacute kidney injury

CIconfidence interval

CKDchronic kidney disease

CPRcardiopulmonary resuscitation

CRRTcontinuous renal replacement therapy

DNRdo not resuscitate


eGFRestimated glomerular filtration rate

ICUintensive care unit


MOFmulti-organ failure

ORodds ratio

POby mouth per os

RRTrenal replacement therapy.

Electronic supplementary materialThe online version of this article doi:10.1186-cc11872 contains supplementary material, which is available to authorized users.

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Autor: Jung Nam An - Jung Pyo Lee - Hee Jung Jeon - Do Hyoung Kim - Yun Kyu Oh - Yon Su Kim - Chun Soo Lim


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