Abstract
Severe hyperkalemia is a life threatening condition that can cause fatal rhythm disturbance and terminal heart arrest. The most common cause of hyperkalemia in older patients is that of iatrogenic medication-related etiology due to associated polymorbidity, polypharmacy and reduced reserve metabolic capacity. The aim of this paper is to increase awareness in the clinicians of the risk of hyperkalemia in elderly patients treated by potassium sparing drugs. We present two case reports of hyperkalemia ≥ 9.0 mmol/L induced by potassium sparing medications with cardiac arrhythmias and severe ECG changes including atrial asystole, disturbance of intraventricular conduction and morphological changes such as tenting T waves and deformed wide QRS complexes. The most frequent causes of hyperkalemia in elderly patients are discussed and electrocardiogram changes and arrhythmias in hyperkalemia are analyzed, as well as their treatment and prevention. Potassium sparing drug therapy in older persons requires more frequent monitoring especially when drugs or their doses are changed, or during concomitant acute illness.
Highlights
Potassium imbalance represents the most common electrolyte disturbance in older patients
More frequent use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists and direct renin inhibitors, often combined with other potassium sparing drugs in the management of chronic cardiovascular diseases, contributed to increased incidence of clinically significant hyperkalemia in clinical practice, often in older patients4-12. 75% of hyperkalemia cases in institutionalized patients are induced by potassium sparing drugs (Table 2)
The incidence of hyperkalemia is increasing in the elderly given the large number of risk factors
Summary
Potassium imbalance represents the most common electrolyte disturbance in older patients. Though hypokalemia is known to be associated with increased hospitalization and mortality in patients with cardiovascular and renal diseases[1,2], severe hyperkalemia is a life threatening condition too[3]. It may be registered in oligoanuric renal failure patients and other acute conditions (Table 1). We present two case reports of hyperkalemia ≥ 9.0 mmol/L induced by potassium sparing medications with cardiac arrhythmias and severe ECG changes including atrial asystole, disturbance of intraventricular conduction and morphological changes such as tenting T waves and deformed wide QRS complexes. Potassium sparing drug therapy in older persons requires more frequent monitoring especially when drugs or their doses are changed, or during concomitant acute illness
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