Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study
Abstract Background Elevated potassium level is a common and reversible peri-arrest condition. Diagnosis and management of hyperkalemia in a short time is critical, where electrocardiogram (ECG) alterations might be helpful. We aimed to investigate the role of clinical features and ECGs in early dia...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-022-00422-8 |
| _version_ | 1817989597440770048 |
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| author | Liqaa A. Raffee Khaled Z. Alawneh Muhannad J. Ababneh Heba H. Hijazi Rabah M. Al abdi Mahmoud M. Aboozour Fadi A. Alghzawi Abdel-Hameed Al-Mistarehi |
| author_facet | Liqaa A. Raffee Khaled Z. Alawneh Muhannad J. Ababneh Heba H. Hijazi Rabah M. Al abdi Mahmoud M. Aboozour Fadi A. Alghzawi Abdel-Hameed Al-Mistarehi |
| author_sort | Liqaa A. Raffee |
| collection | DOAJ |
| description | Abstract Background Elevated potassium level is a common and reversible peri-arrest condition. Diagnosis and management of hyperkalemia in a short time is critical, where electrocardiogram (ECG) alterations might be helpful. We aimed to investigate the role of clinical features and ECGs in early diagnosing and treating hyperkalemia. Methods Prospectively, adult patients who presented to the emergency department (ED) from July 2019 to March 2020 with hyperkalemia (serum potassium ≥5.5mmol/L) were included. History was obtained, and laboratory investigations and ECGs were performed at the presentation and before initiating hyperkalemia therapy. Hyperkalemia severity was divided into mild (5.5–5.9mmol/L), moderate (6.0–6.4mmol/L), and severe (≥6.5mmol/L). A cardiologist and emergency physician blinded to laboratory values, study design, and patients’ diagnoses interpreted ECGs and presenting symptoms independently to predict hyperkalemia. Results Sixty-seven hyperkalemic patients with a mean (±SD) serum potassium level of 6.5±0.7mmol/L were included in this study. The mean age was 63.9±15.1, and 58.2% were females. Hyperkalemia was mild in 10.4%, moderate in 40.3%, and severe in 49.3%. Almost two thirds of patients (71.6%) had hypertension, 67.2% diabetes, and 64.2% chronic kidney disease. About one-quarter of patients (22.4%) were asymptomatic, while fatigue (46.3%), dyspnea (28.4%), and nausea/vomiting (20.9%) were the most common presenting symptoms. Normal ECGs were observed in 25.4% of patients, while alterations in 74.6%. Atrial fibrillation (13.4%), peaked T wave (11.9%), widened QRS (11.9%), prolonged PR interval (10.5%), and flattening P wave (10.5%) were the most common. Peaked T wave was significantly more common in severe hyperkalemia (87.5%) than in mild and moderate hyperkalemia (12.5%, 0.0%, respectively) (p=0.041). The physicians’ sensitivities for predicting hyperkalemia were 35.8% and 28.4%, improved to 51.5% and 42.4%, respectively, when limiting the analyses to severe hyperkalemia. The mean (±SD) time to initial hyperkalemia treatment was 63.8±31.5 min. Potassium levels were positively correlated with PR interval (r=0.283, p=0.038), QRS duration (r=0.361, p=0.003), peaked T wave (r=0.242, p=0.041), and serum levels of creatinine (r=0.347, p=0.004), BUN (r=0.312, p=0.008), and CK (r=0.373, p=0.039). Conclusions The physicians’ abilities to predict hyperkalemia based on ECG and symptoms were poor. ECG could not be solely relied on, and serum potassium tests should be conducted for accurate diagnosis. |
| first_indexed | 2024-04-14T00:49:09Z |
| format | Article |
| id | doaj.art-b4d237a328be4acc90a21ce4d13ef98f |
| institution | Directory Open Access Journal |
| issn | 1865-1372 1865-1380 |
| language | English |
| last_indexed | 2024-04-14T00:49:09Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-b4d237a328be4acc90a21ce4d13ef98f2022-12-22T02:21:53ZengBMCInternational Journal of Emergency Medicine1865-13721865-13802022-05-0115111410.1186/s12245-022-00422-8Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective studyLiqaa A. Raffee0Khaled Z. Alawneh1Muhannad J. Ababneh2Heba H. Hijazi3Rabah M. Al abdi4Mahmoud M. Aboozour5Fadi A. Alghzawi6Abdel-Hameed Al-Mistarehi7Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and TechnologyDepartment of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and TechnologyDivision of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and TechnologyChair of Department of Health Services Administration, College of Health Sciences, University of SharjahDepartment of Biomedical Engineering, Faculty of Engineering, Jordan University of Science and TechnologyDepartment of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and TechnologyDepartment of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and TechnologyDepartment of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and TechnologyAbstract Background Elevated potassium level is a common and reversible peri-arrest condition. Diagnosis and management of hyperkalemia in a short time is critical, where electrocardiogram (ECG) alterations might be helpful. We aimed to investigate the role of clinical features and ECGs in early diagnosing and treating hyperkalemia. Methods Prospectively, adult patients who presented to the emergency department (ED) from July 2019 to March 2020 with hyperkalemia (serum potassium ≥5.5mmol/L) were included. History was obtained, and laboratory investigations and ECGs were performed at the presentation and before initiating hyperkalemia therapy. Hyperkalemia severity was divided into mild (5.5–5.9mmol/L), moderate (6.0–6.4mmol/L), and severe (≥6.5mmol/L). A cardiologist and emergency physician blinded to laboratory values, study design, and patients’ diagnoses interpreted ECGs and presenting symptoms independently to predict hyperkalemia. Results Sixty-seven hyperkalemic patients with a mean (±SD) serum potassium level of 6.5±0.7mmol/L were included in this study. The mean age was 63.9±15.1, and 58.2% were females. Hyperkalemia was mild in 10.4%, moderate in 40.3%, and severe in 49.3%. Almost two thirds of patients (71.6%) had hypertension, 67.2% diabetes, and 64.2% chronic kidney disease. About one-quarter of patients (22.4%) were asymptomatic, while fatigue (46.3%), dyspnea (28.4%), and nausea/vomiting (20.9%) were the most common presenting symptoms. Normal ECGs were observed in 25.4% of patients, while alterations in 74.6%. Atrial fibrillation (13.4%), peaked T wave (11.9%), widened QRS (11.9%), prolonged PR interval (10.5%), and flattening P wave (10.5%) were the most common. Peaked T wave was significantly more common in severe hyperkalemia (87.5%) than in mild and moderate hyperkalemia (12.5%, 0.0%, respectively) (p=0.041). The physicians’ sensitivities for predicting hyperkalemia were 35.8% and 28.4%, improved to 51.5% and 42.4%, respectively, when limiting the analyses to severe hyperkalemia. The mean (±SD) time to initial hyperkalemia treatment was 63.8±31.5 min. Potassium levels were positively correlated with PR interval (r=0.283, p=0.038), QRS duration (r=0.361, p=0.003), peaked T wave (r=0.242, p=0.041), and serum levels of creatinine (r=0.347, p=0.004), BUN (r=0.312, p=0.008), and CK (r=0.373, p=0.039). Conclusions The physicians’ abilities to predict hyperkalemia based on ECG and symptoms were poor. ECG could not be solely relied on, and serum potassium tests should be conducted for accurate diagnosis.https://doi.org/10.1186/s12245-022-00422-8Serum potassiumHyperkalemiaElectrocardiogramECGSensitivity |
| spellingShingle | Liqaa A. Raffee Khaled Z. Alawneh Muhannad J. Ababneh Heba H. Hijazi Rabah M. Al abdi Mahmoud M. Aboozour Fadi A. Alghzawi Abdel-Hameed Al-Mistarehi Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study International Journal of Emergency Medicine Serum potassium Hyperkalemia Electrocardiogram ECG Sensitivity |
| title | Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study |
| title_full | Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study |
| title_fullStr | Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study |
| title_full_unstemmed | Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study |
| title_short | Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study |
| title_sort | clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings a prospective study |
| topic | Serum potassium Hyperkalemia Electrocardiogram ECG Sensitivity |
| url | https://doi.org/10.1186/s12245-022-00422-8 |
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