To enable diagnosis of hyperkalemia from the perimortem blood sample, we aim to describe the natural dynamics of blood potassium [K+ ] in patients dying after withdrawal of care while in an intensive care unit. In a nested sub-study of international Death Prediction and Physiology after Removal of Therapy (DePPaRT) project, we obtained serial whole-blood samples and analyzed ions and acid-base parameters in 23 patients just before life-sustaining treatment withdrawal, at the time of death, and after 5 and 30 min after death. Of the 631 patients in the DePPaRT study, we obtained consent and enrolled 23 subjects in the [K+ ] sub-study (12 M, 11F, aged 73 ± 14 years), mostly dying from irreversible brain damage or multi-organ failure. Blood [K+ ] rose from the median 4.3 (IQR 3.9; 4.8) mEq/L at treatment withdrawal to 5.2 (IQR 5.0; 6.8) mEq/L at death and then to 5.85 (IQR 5.2; 6.8) mEq/L after 30 min (mean rise of +0.64 mEq.L-1 .h-1 ). These changes were associated with progressive lactic and hypercapnic acidemia. After correcting the measured [K+] for pH by subtracting 0.6 mEq/L from [K+] for every 0.1 pH decrease from 7.40, the calculated [K+] remained normal or decreased from that measured at treatment withdrawal. In contrast to the late autolysis phase, the early changes of blood [K+ ] after death are slow and can be fully explained by progressive acidemia. Our data suggest that the diagnosis of hyperkalemia at death from a blood sample obtained within 30 min after death can be made by adjusting the [K+] concentration to a pH 7.40.
- MeSH
- Potassium * MeSH
- Hyperkalemia * complications MeSH
- Ions MeSH
- Intensive Care Units MeSH
- Cohort Studies MeSH
- Humans MeSH
- Prospective Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
AIMS: To investigate the impact of patiromer on the serum potassium level and its ability to enable specified target doses of renin-angiotensin-aldosterone system inhibitor (RAASi) use in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: A total of 1642 patients with HFrEF and current or a history of RAASi-related hyperkalemia were screened and 1195 were enrolled in the run-in phase with patiromer and optimization of the RAASi therapy [≥50% recommended dose of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, and 50 mg of mineralocorticoid receptor antagonist (MRA) spironolactone or eplerenone]. Specified target doses of the RAASi therapy were achieved in 878 (84.6%) patients; 439 were randomized to patiromer and 439 to placebo. All patients, physicians, and outcome assessors were blinded to treatment assignment. The primary endpoint was between-group difference in the adjusted mean change in serum potassium. Five hierarchical secondary endpoints were assessed. At the end of treatment, the median (interquartile range) duration of follow-up was 27 (13-43) weeks, the adjusted mean change in potassium was +0.03 mmol/l in the patiromer group and +0.13 mmol/l in the placebo group [difference in the adjusted mean change between patiromer and placebo: -0.10 mmol/l (95% confidence interval, CI -0.13, 0.07); P < 0.001]. Risk of hyperkalemia >5.5 mmol/l [hazard ratio (HR) 0.63; 95% CI 0.45, 0.87; P = 0.006), reduction of MRA dose (HR 0.62; 95% CI 0.45, 0.87; P = 0.006), and total adjusted hyperkalemia events/100 person-years (77.7 vs. 118.2; HR 0.66; 95% CI 0.53, 0.81; P < 0.001) were lower with patiromer. Hyperkalemia-related morbidity-adjusted events (win ratio 1.53, P < 0.001) and total RAASi use score (win ratio 1.25, P = 0.048) favored the patiromer arm. Adverse events were similar between groups. CONCLUSION: Concurrent use of patiromer and high-dose MRAs reduces the risk of recurrent hyperkalemia (ClinicalTrials.gov: NCT03888066).
- MeSH
- Mineralocorticoid Receptor Antagonists adverse effects MeSH
- Potassium MeSH
- Hyperkalemia * drug therapy complications MeSH
- Humans MeSH
- Renin-Angiotensin System MeSH
- Heart Failure * complications drug therapy MeSH
- Stroke Volume MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
Terapie srdečního selhání zahrnuje používání řady léků, které významně ovlivňují hladinu draslíku. Zatímco diuretika hladinu draslíku snižují, jiné léky (inhibitory angiotenzin konvertujícího enzymu, blokátory AT2 receptorů, sakubitril/valsartan, spironolakton) naopak zvyšují. Pacienti mají rovněž řadu komorbidit, které mohou významně snížit renální funkce, a tedy ovlivnit výslednou hladinu draslíku. Snížená nebo naopak zvýšená hladina draslíku může být pro pacienta velmi nebezpečná, a proto je potřeba ji sledovat. V posledních letech byly publikovány výsledky řady studií, které analyzovaly vztah hladiny draslíku a mortality u nemocných se srdečním selháním a prokázaly, že optimální hladina draslíku by se v této skupině pacientů měla pohybovat v rozmezí 4-5 mmol/.
Heart failure therapy involves the use of a number drugs that significantly affect potassium levels. While diuretics decrease potassium levels, others (angiotensin converting enzyme inhibitors, AT2 receptor blockers, sacubitril/valsartan, spironolactone) increase. Patients also have several comorbidities that can significantly reduce renal function and thus affect the resulting potassium level. Decreased or elevated potassium levels can be very dangerous for the patient and therefore need to be monitored. In recent years, the results of several studies have been published that have focused on potassium levels and mortality and have shown that the optimal potassium levels in patients with heart failure should be between 4-5 mmol/L.
- MeSH
- Potassium * physiology adverse effects MeSH
- Hyperkalemia chemically induced drug therapy complications physiopathology MeSH
- Hypokalemia complications physiopathology MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Monitoring, Physiologic MeSH
- Mortality MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Heart Disease Risk Factors MeSH
- Heart Failure drug therapy complications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
U srdečního selhání je hyperkalemie problémem hned z několika důvodů, jimiž jsou například neurohumorální mechanismy v patofyziologii tohoto onemocnění, renální selhání, komorbidity a také léky, které přinášejí prognostický prospěch. Mezi takové léky patří inhibitory renin‑angiotenzin‑aldosteronového systému, které mohou zvyšovat hodnoty kalemie, zejména při kombinaci s jinými léčivy (např. s nesteroidními antirevmatiky). Pokud hyperkalemie není korigovaná, může mít závažné důsledky zejména pro srdce. Proto je velmi důležité respektovat některá pravidla ‒ uvážlivě předepisovat léky, které ovlivňují kalemii, brát v úvahu všechny faktory, které zvyšují riziko hyperkalemie, a pokud hyperkalemie vznikne, zahájit včas její léčbu. V tomto přehledu jsou shrnuty obvyklé postupy v léčbě hyperkalemie a rovněž diskutovány nové molekuly, jež mohou snížit riziko vzniku hyperkalemie (finerenon) nebo mohou účinně zmírňovat kalemii (chelační polymer patiromer či iontové síto zirkonium‑cyklosilikát sodný).
In heart failure, hyperkalaemia is a frequent problem because of several factors, such as neurohumoral mechanisms involved in pathophysiology of the disease, renal failure, comorbidities, and also drugs with prognostic benefit. Among such drugs are inhibitors of the renin‑angiotensin‑aldosterone system, which can increase potassium levels, especially when combined with other drugs, such as nonsteroidal antirheumatics and others. Hyperkalaemia can have severe consequences, if not corrected, mostly cardiac. Therefore, it is important to respect some rules, like prescribing drugs influencing potassium levels prudently, managing all factors increasing the risk of hyperkalaemia, and treating hyperkalaemia immediately if it develops. This overview summarizes all usual treatments of hyperkalaemia. New molecules are also discussed that can decrease the risk of developing hyperkalaemia, like finerenone, or decrease plasma potassium effectively, like chelating polymer patiromer or ion sieve sodium zirkonium cyclosilicate.
- MeSH
- Electrocardiography MeSH
- Hyperkalemia * etiology drug therapy complications MeSH
- Angiotensin-Converting Enzyme Inhibitors administration & dosage adverse effects therapeutic use MeSH
- Ions MeSH
- Investigational New Drug Application * methods MeSH
- Disease Attributes MeSH
- Humans MeSH
- Naphthyridines administration & dosage adverse effects therapeutic use MeSH
- Kidney Diseases complications MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Polymers therapeutic use MeSH
- Randomized Controlled Trials as Topic MeSH
- Renin-Angiotensin System physiology drug effects MeSH
- Risk Factors MeSH
- Silicates MeSH
- Heart Failure * drug therapy complications prevention & control MeSH
- Statistics as Topic MeSH
- Age Factors MeSH
- Zirconium MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- Keywords
- sacubitril-valsartan, LCZ 696, finerenon,
- MeSH
- Aminobutyrates therapeutic use MeSH
- Anemia diagnosis complications therapy MeSH
- Chronic Disease MeSH
- Hyperkalemia diagnosis complications therapy MeSH
- Administration, Intravenous MeSH
- Cardiotonic Agents therapeutic use MeSH
- Evidence-Based Practice MeSH
- Humans MeSH
- Naphthyridines therapeutic use MeSH
- Practice Guidelines as Topic MeSH
- Heart Failure * diagnosis complications therapy MeSH
- Tetrazoles therapeutic use MeSH
- Treatment Outcome MeSH
- Iron therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Biomarkers MeSH
- Diagnostic Techniques, Neurological MeSH
- Genetic Testing MeSH
- Hyperkalemia diagnosis complications therapy MeSH
- Hypokalemia diagnosis complications therapy MeSH
- Ion Channels * physiology metabolism drug effects MeSH
- Disease Attributes MeSH
- Humans MeSH
- Neuromuscular Diseases * diagnosis classification therapy MeSH
- Paralyses, Familial Periodic * diagnosis etiology classification MeSH
- Reference Books, Medical MeSH
- Thyrotoxicosis diagnosis enzymology metabolism MeSH
- Check Tag
- Humans MeSH
- MeSH
- Adult MeSH
- Embolism, Fat etiology complications mortality MeSH
- Femoral Neck Fractures complications mortality MeSH
- Hyperkalemia etiology complications mortality MeSH
- Myocardial Infarction complications mortality nursing MeSH
- Cardiopulmonary Resuscitation * MeSH
- Blood Circulation * physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Treatment Failure * MeSH
- Recovery of Function * physiology MeSH
- Airway Obstruction complications mortality nursing MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Death * MeSH
- Emergency Medicine MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Overall MeSH
Autoři předkládají dvě názorné kazuistiky hyperkalémie s projevy kardiotoxicity u polymorbidních pacientů s akutní gastroenteritidou. K hyperkalémii výrazně přispěla užívaná medikace. Cílem práce je upozornit ošetřující lékaře na rizika diuretické a hypoglykemizující medikace u chronicky nemocných pacientů především při akutních onemocněních zažívacího traktu.
The authors present two educative case-reports of hyperkalemia with signs of cardiotoxicity in polymorbid patients with acute gastroenteritis. Concomitantly used long-term medication contributed to the hyperkalemia significantly. The aim of this article is to warn physicians about risks of diuretic and hypoglycemic therapy in chronically ill patients and especially in acute gastrointestinal disorders.
- MeSH
- Acidosis * diagnosis chemically induced blood MeSH
- Bradycardia MeSH
- Diuretics adverse effects MeSH
- Electrocardiography MeSH
- Fatal Outcome MeSH
- Ventricular Fibrillation MeSH
- Gastroenteritis * complications MeSH
- Calcium Gluconate therapeutic use MeSH
- Hyperkalemia * etiology drug therapy complications MeSH
- Hypoglycemic Agents adverse effects MeSH
- Humans MeSH
- Critical Care MeSH
- Polypharmacy * MeSH
- Renal Insufficiency chemically induced complications MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
Zvýšená hladina sérového kalia se často vyskytuje u hospitalizovaných dětí a může je potencionálně ohrožovat na životě. Proto je nutno zejména v případě rychlého vzestupu hladin kalia, při nálezu EKG změn, snížené funkce ledvin a u pacientů s acidózou přistoupit k včasné léčbě, jejímž cílem je zabránění rozvoje závažných arytmií. Při selhání konzervativní terapie je na místě zahájení dialyzační léčby.
Elevated potassium is a common problem seen in hospitalized children and can be potentially life-threatening. Emergency management is warranted especially in cases with rapidly rising potassium values, ECG changes, decreased renal functions and presence of significant acidosis. The goal of the therapy is a prevention of severe arrhytmias development. Renal replacement therapy is used when conservative methods fail.
