Average Serum Potassium Level Research Articles

A single-center retrospective study on the clinical features of thyrotoxic periodic paralysis.

Thyrotoxic periodic paralysis (TPP) is characterized by muscle paralysis and significant intracellular potassium movement resulting in hypokalemia. Since TPP is a rare condition, only a few studies have explicated the clinical characteristics of patients with this disease. This study aimed to elucidate the clinical characteristics of patients with TPP by comparing them with those with thyrotoxicosis without paralysis (non-TPP) and sporadic periodic paralysis (SPP). This was a single-center retrospective cohort study. Clinical data of patients with hyperthyroidism (n = 62) or periodic paralysis (n = 92) who were emergently admitted to our hospital was extracted from the electronic medical records and analyzed. All patients in the TPP group (15 males and 2 females) had Graves' disease, with 14 being newly diagnosed. The average serum potassium level on admission was 2.3±0.75 mEq/L. No significant correlation was observed among serum potassium level, amount of potassium required for normalization, and thyroid hormone levels. The TPP group showed significantly younger age, higher male ratio and body mass index (BMI), and lower serum potassium and phosphorus levels than the non-TPP group, which comprised 36 patients with Graves' disease. No significant differences were observed between the TPP and SPP (n = 11) groups in terms of age, sex, BMI, serum electrolyte levels, potassium requirement for normalization, and recovery time. Considering that most patients with TPP have undiagnosed Graves' disease, distinguishing TPP from SPP based on clinical information and course alone is difficult in emergency settings. Therefore, for early detection and launch of specific treatment of Graves' disease, screening for thyroid hormone and anti-thyroid stimulating hormone receptor antibody levels is necessary when treating patients with periodic paralysis.

6.22 The Combination of Kampo and Western Antipsychotic Drugs Were Effective for 20 Cases in Child Psychiatric Outpatients

Kampo is the Japanese herbal traditional medicine formula, with a root from ancient China, that is used for irritation, mood swing, and agitation in Japan. Ninety percent of Japanese doctors have an experience of prescribing Kampo, and 80% of doctors have combined Kampo and a Western antipsychotic drug (WAD). The indication of atypical WAD is for the irritability and agitation with autism spectrum disorder (ASD), and Kampo is used for peripheral symptoms in the child and adolescent psychiatric patient. For now, risperidone and aripiprazole are the only choices under the Japanese health insurance system to treat children with ASD. This retrospective case series report was conducted in 20 children who received Kampo and a WAD, from April 1, 2017 to December 31, 2020, at our child and adolescent psychiatric outpatient clinic. Their ages ranged from 7 to 19 years. Their age, gender, IQ test (Wechsler Intelligence Scale for Children–Fourth Edition [WISC-4], Tanaka-Binet-5 test, Kyoto Scale of Psychological Development), the severity that DSM-5 defines on the initial examination and the end of this research (none = Level 0, mild = Level 1, moderate = Level 2, severe = Level 3), dropouts, side effects, and the number of medications were surveyed. The average age was 12.2 years (7-19). The ratio of males to females was 19:1. The average IQ was 69.4 (22-143). There were no side effects from Kampo. Seven children had a blood test, and their average serum potassium level was 4.0 mEq/l (3.5-4.4). In addition, 0.5 (25%) of them had any type of drug and food allergies, 6 (30%) had febrile convulsion, abnormality of EEG, and epilepsy, and 3 (15%) had any severe physical disabilities. The initial diagnosis (maximum 2) was 11 (55%) with pervasive developmental disorder and ASD, 9 (45%) with ADHD, 2 (10%) with ODD, 12 (60%) with intellectual disability containing below average IQ (BAIQ), 14 (70%) had continued combined medicine, 5 (25%) had dropped out of the child and adolescent psychiatric outpatient clinic, 6 (30%) had taken multiple WADs. The average Kampo dose per day was 4.6 g (1 package is 2.5 g). The average administration duration was 14.4 month (2-41). The price of a risperidone tablet (2 mg) is $0.40 USD, aripiprazole (3 mg) is $0.60 USD, and Kampo is $0.34 to $0.16 USD per 1 package. The average severity level according to the DSM-5 on the initial examination was 1.95 (1-3). The average severity at the end of this research was 1.17 (0-3). The combination of Kampo and WADs might alleviate the severity of children in the child and adolescent psychiatric outpatient.

Hypokalemia in peritoneal dialysis patients in Thailand: the pivotal role of low potassium intake.

Hypokalemia is highly prevalent in chronic peritoneal dialysis (PD) patients worldwide, particularly in Thailand. This study aims to investigate the major determinants of hypokalemia in Thai PD patients. A cross-sectional study was performed in chronic PD patients at 4 PD centers in Bangkok, Thailand. Hypokalemia was defined if the average serum potassium level during the last 3 consecutive visits was < 3.5mEq/L. Patients and/or their caregivers were asked to perform a 3-day dietary food record and take pre- and post-meal pictures following the instructed protocol. Daily dietary nutrients, including potassium, were estimated by a single dietician using INMUCAL-N software. Total potassium excretion was determined by 24-h PD effluents and urine collection. Intracellular and extracellular water values (ICW and ECW, respectively) were measured by electrical bioimpedance assay (BIA) to indirectly explore the role of intracellular potassium shift in hypokalemia. Among 60 eligible PD patients, 19 (31%) had hypokalemia. Hypokalemic patients had significantly lower dietary potassium intake (24.4 ± 11.1 vs. 30.5 ± 9.4mEq/day, p = 0.031) and lower total potassium excretion (28.5 ± 8.4 vs. 36.7 ± 11.2mEq/day, p = 0.006) compared to normokalemic patients. Both groups had comparable values of ICW and ECW. On logistic regression, there was no significant correlation between hypokalemia and daily PD exchange volume, total Kt/Vurea, residual renal function, concurrent medications (insulin, diuretics, renin-angiotensin-aldosterone inhibitor, and beta-blockers) or ICW. Low dietary potassium was an independent risk factor for hypokalemia. Low dietary potassium intake, rather than increased potassium excretion or intracellular shift, is the major contributing factor of hypokalemia in Thai chronic PD patients. Dietary intervention or potassium supplement protocol should be implemented.

Electrolytes imbalance caused by amikacin in patients receiving multi drug resistance- tuberculosis treatment at Hazara region Kpk, Pakistan.

Multi drug resistance-tuberculosis (MDR-TB) is considered amongst one of the fatal medical and public health issue. Greater frequency of adverse reactions has been observed using 2nd line antituberculosis drugs, which rises the rate of morbidity. Hypokalemia and hyponatremia are common in patients receiving MDR-TB treatment. This study was aimed to assess the effect of amikacin as multidrug resistance tuberculosis treatment on serum sodium and potassium level. A total 179 subjects (82 males and 97 females) were screened within the period of one year for their serum electrolyte levels before and during the treatment. Their body weight and sociodemographic characteristics were also taken into considerations. Data were expressed in the form of mean ± standard error using One-way analysis of variance (ANOVA), followed by Dunnett's test. All the statistical analyses were performed using GraphPad Prism v. 6. The results showed that amikacin caused a significant (p< 0.05) hypokalemia when used in combination with other drugs having no known effect on serum potassium level which proved to be the side effect of amikacin. The average serum potassium level in both intensive and continuation phase was significantly lower (p< 0.05) than the baseline (3.73 mmol/L), however, in the continuation phase the potassium level (3.58 mmol/L) was slightly higher than that of intensive phase (3.54 mmol/L). The average serum sodium level in both phases; intensive and continuation, remained in steady state (137.25 mmol/L and 137.87 mmol/L respectively) throughout the study period as compared to the base line (135.5 mmol/L). The amikacin drug lowered serum potassium level but had no effect on sodium level. It is concluded that the serum electrolytes should be monitored during the course of treatment and corrected accordingly.

Serum Potassium Profile and Associated Factors in Incident Peritoneal Dialysis Patients

Background/Aims: Abnormal potassium profiles are common in peritoneal dialysis (PD) patients. We studied the factors associated with serum potassium profiles in incident PD patients. Methods: Patients were enrolled from two hospital-facilitated PD centers from May 2013 to May 2016 and January 2009 to December 2015. A total of 319 incident PD patients were examined for factors associated with serum potassium profile. Average serum potassium levels were obtained for analysis during the first 3 months after PD initiation. Clinically factors and parameters associated with PD were assessed by logistic regression. Results: There were 168 men and 151 women (mean age, 50.8 years). Blood urea nitrogen (BUN), creatinine (Cr), and intact parathyroid hormone levels were significantly increased in patients in the higher serum potassium group. There were no significant risk factors for hypokalemia, including sex, age, diabetes, blood examination parameters, medication use, or PD-related parameters by multivariate logistic regression analysis. BUN (adjusted odds ratio [OR] 1.02, 95% CI 1.01-1.03, p = 0.001) and Cr (adjusted OR 1.08, 95% CI 1.01-1.16, p = 0.029) levels were significant risk factors for hyperkalemia by multivariate logistic regression analysis. Conclusion: Hyperkalemia and blood BUN and Cr levels were significantly associated in incident PD patients.

Study of the Effect of Amlodipine, Atenolol, Enalapril and Losartan in Patients with Mild to Moderate Hypertension

Objectives: To evaluate and compare the efficacy and tolerability of amlodipine, atenolol, enalapril and losartan in patients with mild to moderate hypertension. Research design and method: This study was conducted in medicine department of tertiary care teaching hospital. This was prospective, open labelled, observational, randomized controlled clinical trial. Patients aged 30-60 years, newly diagnosed as mild to moderate hypertension were enrolled in the study. Pretreatmentevaluation of all the patients was done. Detailed clinical history, physical examination and routine laboratory investigations were done. Eligible patients were randomized to receive Amlodipine 2.5/5 mg, Atenolol 25/ 50 mg, Enalapril5/ 10 mg, Losartan 25/50 mg and followed them for 12 weeks, patient’svisits scheduled at 2 weeks interval. Primary efficacy end point was reduction in mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP). Safety was assessed in terms of systemic adverse events both subjective and objective (clinical and biochemical examinations). Results: Total 154 patients were enrolled, patients’ demographic and baseline clinical characteristics were comparable in all treatment groups. After 12 weeks of treatment the reduction in mean systolic blood pressure were 22.55±7.74, 21±7.94, 20.35±5.48, 22.61±8.41. Reduction in mean diastolic blood pressure were 13.11±4.31, 10.11±3.24, 11.5±3.39, 12.72±3.38. The change in heart rate was 84.22 ± 5.71 to 85.56 ± 5.81, 83.27 ± 5.72 to 69.05 ± 7.68, 84 ± 6.17 to 85.72±5.47, 82.33 ± 7.15 to 83.5±7.54. The change in average serum potassium levels 3.81 ± 0.39 to 3.79 ± 0.36, 3.79 ± 0.33 to 3.69 ± 0.22, 3.72 ± 0.35 to 4.08 ± 0.38, 3.74 ± 0.40 to 3.81 ± 0.27. Adverse events percentage was 38.88 percent, 36.11 percent, 36.11 percent and 13.88 percent in all 4 study group respectively. Conclusion: Amlodipine, Atenolol, Enalapril, and Losartan are equal efficacious to reduce SBP and DBP, whereas losartan is better tolerated and comparatively safer than amlodipine, atenolol and enalapril in patients with mild to moderate hypertension.

Relation of Serum Potassium Level to Long-Term Outcomes in Patients With Acute Myocardial Infarction

Potassium plays a key role in normal myocardial function, and current guidelines recommend that serum potassium levels be maintained from 4.0 to 5.0 mEq/L in patients with acute myocardial infarction (AMI). However, the impact of serum potassium levels on long-term mortality has not been evaluated. We retrospectively studied 1,924 patients diagnosed with AMI. The average serum potassium levels measured throughout the hospitalization were obtained and statistically analyzed. Patients were categorized into 5 groups to determine the relation between mean serum potassium and long-term mortality: <3.5, 3.5 to <4.0, 4.0 to <4.5, 4.5 to <5.0, and ≥5 mEq/L. The long-term mortality was lowest in the group of patients with potassium levels of 3.5 to <4.0 mEq/L, whereas mortality was higher in the patients with potassium levels≥4.5 or <3.5 mEq/L. In a multivariate Cox-proportional regression analysis, the mortality risk was greater for serum potassium levels of >4.5 mEq/L (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.04 to 2.81 and HR 4.78, 95% CI 2.14 to 10.69, for patients with potassium levels of 4.5 to <5.0 mEq/L and ≥5.0, respectively) compared with patients with potassium levels of 3.5 to <4.0 mEq/L. The mortality risk was also higher for patients with potassium levels<3.5 mEq/L (HR 1.55, 95% CI 0.94 to 2.56). In contrast to the association with long-term mortality, there was no relation between serum potassium levels and the occurrence of ventricular arrhythmias. The results of the current analysis suggest that there is a need for change in our current concepts of the ideal serum potassium levels in patients with AMI.

Significance of Serum Potassium Level Monitoring during the Course of Post‐Operative Rehabilitation in Patients with Hypokalemia

Our objective was to evaluate the significance of pre-hospital and post-operative serum potassium level monitoring and hypokalemia intervention in laparotomy patients with hypokalemia. A total of 118 laparotomy patients with hypokalemia were randomly divided into an intervention group (N = 60) and a control group (N = 58). Blood samples were collected for measurement of potassium levels at various time points (pre-admission, admission, 24 h and 48 h post-operation) for both groups. Hypokalemia interventions were administered to patients in the intervention group in the pre-admission period and the post-operative period. Visceral dynamics were assessed after laparotomy in both groups. Average serum potassium levels at admission, time period of drinking, and time of first bowel sound after laparotomy differed significantly (p < 0.001) between the two groups. Average serum potassium levels, first time of defecation, urination, and ambulation at 24 h and 48 h post-operation differed significantly (p < 0.05) between the two groups. An optimal pathway of serum potassium monitoring not only saves limited ward space but also allows for early correction of hypokalemia in patients undergoing laparotomy.

Hypokalemia in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Implication

Abnormal potassium metabolism may contribute to the increased cardiac morbidity and mortality seen in dialysis patients. We studied the pattern of serum potassium levels in a cohort of Chinese peritoneal dialysis (PD) patients. We studied serum potassium levels of 266 PD patients during 3 consecutive clinic visits. Dialysis adequacy, residual renal function, and nutritional status also were assessed. Patients were followed up for 33.7 +/- 20.7 months. Mean serum potassium level was 3.9 +/- 0.5 mEq/L (mmol/L). Five patients (1.9%) had an average serum potassium level less than 3 mEq/L (mmol/L), whereas 54 patients (20.3%) had a serum potassium level less than 3.5 mEq/L (mmol/L). Serum potassium levels correlated with overall Subjective Global Assessment score (r = 0.276; P < 0.001) and serum albumin level (r = 0.173; P = 0.005) and inversely with Charlson comorbidity score (r = -0.155; P = 0.011). There was no correlation between serum potassium level and daily PD exchange volume, total Kt/V, urine volume, or residual glomerular filtration rate. By means of multivariate analysis with Cox proportional hazard model to adjust for confounders, serum potassium level was an independent predictor of actuarial patient survival. PD patients with hypokalemia (serum potassium < 3.5 mEq/L [mmol/L]) had significantly worse actuarial survival (hazard ratio, 1.79; 95% confidence interval, 1.12 to 2.85; P = 0.015) than those without hypokalemia after adjusting for confounding factors. Hypokalemia is common in Chinese PD patients. Serum potassium level was associated with nutritional status and severity of coexisting comorbid condition. Furthermore, hypokalemia was an independent predictor of survival in PD patients. Additional studies may be needed to investigate the benefit of potassium supplementation for PD patients with hypokalemia.

Utilization of Potassium in the Rapid Phase of Rehydration 25

The rapid initial phase of intravenous rehydration was studied in 51 patients with diarrheal dehydration. All received variable amounts of potassium, in addition to the standard mixture of equal parts of 5% glucose and 0.9% sodium chloride, at the rate of 50 ml/kg/hours. Final concentration of potassium in the infusion fluid ranged from 4 to 21,3 meq/l, achieving an infusion velocity that ranged from 0.08 to 1.38 meq/kg/hour. No untoward effects were observed with the use of potassium; the average serum potassium levels at the end of the period did not increase above those observed on admission (4,2±1 vs 4±0.9 mcq/l). A subgroup of patients underwent metabolic balances. In 8 patients no potassium was administered and an intracellular deficit (as estimated with the “chloride space” of Darrow) of 0,48±0,36 meq/kg, was observed. In another group of 11 patients, who received potassium, intracellular gain of 0,23±0,38 meq/kg was observed. These results point to the fact that potassium can be used safely, even before diuresis ensues, in patients with diarrheal dehydration that need intravenous therapy.

Drug related admissions to a cardiology department; frequency and avoidability

Three hundred and sixty-six consecutive patients admitted to a department of cardiology were evaluated for drug events as a cause of admission. The drug events considered were adverse drug reactions (ADR) and dose-related therapeutic failures (DTF). 'Definite' or 'probable' drug events accounted for 15 admissions (4.1%, 95% confidence limits 2.3-6.7%), of which eleven were ADR and four were DTF. With the inclusion of six 'possible' drug events, the rate of drug-related hospitalizations (DRH) was 5.7%. DRHs were characterized by a preponderance of acute admissions and elderly patients. Hypokalaemia (less than 3.5 mM) was observed in 27 (16%) patients receiving diuretics, and could be related to four cases of arrhythmias (two 'probable' and two 'possible' ADR). The average serum potassium level was similar in diuretic treated patients with or without drugs to counteract hypokalaemia, irrespective of the drugs chosen. Among the 15 'definite'/'probable' DRHs, five were considered to be due to an error in prescription, and a further five cases were judged to have been avoidable had appropriate measures been taken by prescribing physicians. A DRH educational intervention programme should primarily deal with non-compliance or with prescription of diuretics or digoxin, since these problems constitute the majority of cases of DRH. No specific group of doctors could be targeted as responsible for DRH, avoidable or not.

Response of Thiazide-lnduced Hypokalemia to Amiloride

The effects of amiloride hydrochloride on thiazide-induced hypokalemia were evaluated. In metabolic balance studies, amiloride reversed thiazide-induced urinary potassium loss, restored plasma bicarbonate concentration and pH to pretreatment levels, and produced further increases in aldosterone secretion. Effects of long-term administration of hydrochlorothiazide and an amiloride-hydrochlorothiazide combination were compared in outpatients who had experienced thiazide-induced hypokalemia while receiving oral potassium supplements. After eight weeks, those given hydrochlorothiazide alone had an average serum potassium level of 3.01 +/- 0.08 mEq/L). Those given the amiloride-hydrochlorothiazide combination had an average serum potassium level of 3.75 +/- 0.008 mEq/L, not significantly different from the control value (3.82 +/- 0.08 mEq/L). Both groups had increased plasma aldosterone concentrations and plasma renin activity. The potassium-conserving effect of amiloride persisted with extended therapy.