Intensive Care Management Research Articles

Factors associated with venous thromboembolic disease due to failed thromboprophylaxis

IntroductionAvailable evidence to identify factors independently associated with failed thromboprophylaxis (FT) in medical patients is insufficient. The present study seeks to evaluate in hospitalized patients, which clinical factors are associated with the development of FT.Materials and methodsA case-control study nested to a historical cohort, comparing patients who developed failed thromboprophylaxis (cases) with those who did not (controls). Univariate and multivariate regression analysis was performed to define the factors associated with FT.ResultsWe selected 204 cases and 408 controls (52.4% men, median age 63 years). Medical patients were 78.4%. The most frequent thromboprophylaxis scheme was enoxaparin. In the failed thromboprophylaxis group, most of the embolic events corresponded to pulmonary embolism (53.4%). Among cases, BMI was higher (26.3 vs. 25 kg/m2, p < 0.001), as was the proportion of patients with leukocytosis > 13,000 (27% vs. 18.9%, p:0.22), and patients who required intensive care management (48% vs. 24.8%, p < 0.001). Factors independently associated with FT were BMI (OR1.04;95%CI 1.00-1.09, p:0.39), active cancer (OR:1.63;95%IC 1.03–2.57, p:0.04), leukocytosis (OR:1.64;95%CI 1.05–2.57, p:0.03) and ICU requirement (OR:3.67;95%CI 2.31–5.83, p < 0.001).ConclusionOur study suggests that the failed thromboprophylaxis is associated with high BMI, active cancer, leukocytosis, and ICU requirement. Future studies should evaluate whether there is benefit in adjusting the thromboprophylaxis scheme in patients with one or more of these factors.

Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy: A Retrospective Observational Study

Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy: A Retrospective Observational Study

Implementation of Clinical Pathways for CAR-T Cell Therapy in a Brazilian Private Healthcare Organization

Introduction: the treatment with CAR-T cells in Brazil is challenging because it requires a highly qualified multidisciplinary team trained in new clinical pathways to take care of these patients. Objective: to describe the implementation of the clinical pathways for CAR-T cell therapy, ensuring safety and quality. Method: this is an experience report study, performed in four private general hospitals of the Americas from São Paulo, Rio de Janeiro and Ceará states, during the year of 2022. The process of implementing the CAR-T Cell clinical pathway included: creation of a medical committee with the main medical references and specialist nurses from each center, for the elaboration of the main clinical protocols and operational procedures, in addition to the discussion of eligibility cases for therapy with CAR-T Cells. Identification of the multidisciplinary reference team in all phases of treatment, training the team involved in the clinical care of the patient, and finally, establishment of patient clinical pathway before, during and after the CAR-T cell therapy. The implementation process lasted seven months between the qualification of centers by the Therapy provider, internal qualification each center and the first cell infusion with CAR-T Cell performed. Results: In all hospitals, professionals from the multidisciplinary team (pharmacy, nursing, physicians - hematologists, pediatric hematology-oncologists involved in hematopoietic stem cell transplantation, neurologists, pediatric and adult intensive care physicians) were trained. The Multidisciplinary Care Protocol was elaborated including indications, early and late complications. The Standard Operating Procedures addressed the pre and post infusion care, daily screening, criteria to transfer the patients to the intensive care unit, recognition and management of cytokine release syndrome and neurological toxicities. The main challenges of this process were to create the routines for evaluation and systematic monitoring and to identify and involve the multidisciplinary professionals directly involved in patient care. Conclusions: the implementation of the program brought improvements to the clinical pathway, positively impacting professional satisfaction, the quality and safety of the patients. The CAR-T cell therapy was performed in a safe and integrated environment, uneventful and successful.

Important Considerations in the Intensive Care Management of Acute Leukemias.

In the realm of hematologic disorders, acute leukemia is approached as an emergent disease given the multitude of complications and challenges that present both as a result of inherent disease pathology and adverse events associated with antineoplastic therapies and interventions. The heavy burden of leukemic cells may lead to complications including tumor lysis syndrome, hyperleukocytosis, leukostasis, and differentiation syndrome, and the initiation of treatment can further exacerbate these effects. Capillary leak syndrome is observed as a result of antineoplastic agents used in acute leukemia, and L-asparaginase, a bacterial-derived enzyme, has a unique side effect profile including association with thrombosis. Thrombohemorrhagic syndrome and malignancy-associated thrombosis are also commonly observed complications due to direct disequilibrium in coagulant and anticoagulant factors. Due to inherent effects on the white blood cell milieu, leukemia patients are inherently immunocompromised and vulnerable to life-threatening sepsis. Lastly, the advents of newer therapies such as chimeric antigen receptor (CAR) T-cells have clinicians facing the management of related toxicities on unfamiliar territory. This review aims to discuss these acute leukemia-associated complications, their pathology, and management recommendations.

Clinical characteristics of patients with cardiac sarcoidosis who were hospitalized for heart failure

Abstract Background Cardiac sarcoidosis (CS) often leads cardiac dysfunction and exacerbates heart failure. However, there are limited data regarding CS patients who were hospitalized for acute heart failure (AHF). Purpose We aimed to compare the patient characteristics and outcomes between patients with CS who were hospitalized for AHF (CS-AHF) and patients with AHF of other etiology. Methods A total of 4,556 hospitalized patients with CS were identified from the Japanese Diagnosis Procedure Combination database from 2012 to 2020. Among them, we analyzed 254 patients who were hospitalized due to AHF. Patient characteristics, prior medical history, medical therapy for heart failure, intensive care management during hospitalization, in-hospital outcomes and rehospitalization within one year after the index hospitalization were compared with general 4,056 hospitalized AHF patients who were enrolled in the Kyoto Congestive Heart Failure registry. Results Patients with CS-AHF were younger (71 [63-78] vs 80 [72-86]) and more women (69% vs 45%; p &amp;lt; 0.001) than general AHF patients. In addition, CS-AHF were associated with lower prevalence of hypertension, diabetes and dyslipidemia (46% vs 72%, p &amp;lt; 0.001; 28% vs 37%, p = 0.005; and 21% vs 38%, p &amp;lt; 0.001), and lower prescription of angiotensin converting enzyme inhibitors or angiotensin II receptor blocker (28 % vs 46%; p &amp;lt; 0.001) while prescription of beta-blockers were similar between the groups. The length of hospital stay was significantly longer in CS-AHF (23 [14-39] days vs 16 [11-25] days), more patients were treated by intensive respiratory care (32% vs 25%; p = 0.05) and cardiac resynchronization therapy defibrillator (CRTD) implantation (6% vs. 0.5%; p &amp;lt; 0.001) Although in-hospital mortality was similar between the groups, the rate of rehospitalization within one year was higher in CS-AHF (51% vs 39%; p = 0.001). Conclusions Patients with CS-AHF were younger, more women and had lower cardiovascular risk factors than those with AHF in general. CS-AHF were associated with longer hospital stay, higher rate of CRTD implantation and higher rehospitalization rates. More attention might be needed for this distinct group of patients.

A case of strongly suspected type B insulin resistance syndrome which developed during intensive care management

A case of strongly suspected type B insulin resistance syndrome which developed during intensive care management

Study of Organophosphorus Poisoning at a Tertiary Care Teaching Hospital

Introduction: Organophosphate (OP) insecticides inhibit both cholinesterase and pseudo-cholinesterase activities. The inhibition of acetylcholinesterase causes accumulation of acetylcholine at synapses, and overstimulation of neurotransmission occurs as a result of this accumulation. The mortality rate of OP poisoning is high. Early diagnosis and appropriate treatment is often life saving. Treatment of OP poisoning consists of intravenous atropine and oximes. The clinical course of OP poisoning may be quite severe and may need intensive care management. Methods: A retrospective study was performed on the patients with OP poisoning. Fifty patients were included. Diagnosis was performed from the history taken either from the patient or from the patient's relatives about the agent involved in the exposure. Diagnosis could was confirmed with serum and red blood cell anticholinesterase levels. Intravenous atropine and pralidoxime was administered as soon as possible. Other measures for the treatment were gastric lavage and administration of activated charcoal via nasogastric tube, and cleansing the patient's body with soap and water. The patients were intubated and mechanically ventilated if the patients had respiratory failure, a depressed level of consciousness, which causes an inability to protect the airway, and hemodynamic instability. Mechanical ventilation was performed as synchronized intermittent mandatory ventilation + pressure support mode, either as volume or pressure control. Positive end expiratory pressure was titrated to keep SaO2 above 94% with 40% FIO2. Weaning was performed using either T-tube trials or pressure support weaning. The chi-square test was used for statistical analysis. Data are presented as mean ± standard deviation. Results: There were 26 female and 24 male patients. Thirty-five were suicide attempts and 15 were accidental exposure. The gastrointestinal route was the main route in 44 patients. The most frequent signs were meiosis, change in mental status, hypersalivation and fasciculations. Ten patients (20.0%) required mechanical ventilation. Complications were observed in 35 patients. These complications were respiratory failure (14 patients), aspiration pneumonia (10 patients), urinary system infection (6 patients), convulsion (4 patients) and septic shock (1 patient). The duration of the intensive care stay was 5.2 ± 3.0 days. Discussion: Ingestion of OP compounds for suicidal purposes is a major problem, especially in developing countries. Thirty-five of our patients used the OP insecticide for suicide. The average respiratory rate of these patients increased from 22 to 38 breaths/min, which is an important sign of respiratory distress. The nurse to patient ratio was increased after these events. Early recognition of respiratory failure resulting in intubation and mechanical ventilation is a life-saving intervention for patients with OP poisoning. Respiratory failure is the most troublesome complication, which was observed in 35 patients. Patients with OP poisoning may have respiratory failure for many reasons, including aspiration of the gastric content, excessive secretions, pneumonia and septicemia complicating acute respiratory distress syndrome. Conclusions: OP insecticide poisoning is a serious condition that needs rapid diagnosis and treatment. Since respiratory failure is the major reason for mortality, careful monitoring, appropriate management and early recognition of this complication may decrease the mortality rate among these patients.

PERSUADE Survey—PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States

ObjectiveTo comprehensively assess relevant institutional variations in anesthesia and intensive care management during left ventricular assist device (LVAD) implantation. DesignProspective data analysis. SettingOnline survey. ParticipantsLVAD-centers in Europe and the United States. InterventionsAfter investigating initial interest, 91 of 202 European and 93 of 195 US centers received a link to the survey targeting institutional organization and experience, perioperative hemodynamic monitoring, medical management, and post-operative intensive care aspects. Measurements and Main ResultsThe survey was completed by 73 (36.1%) European and 60 (30.8%) US centers. Although most LVAD implantations were performed in university hospitals (>5 years’ experience), significant differences were observed in the composition of the preoperative multidisciplinary team and provision of intraoperative care. No significant differences in monitoring or induction agents were observed. Propofol was more often used for maintenance in Europe (p<0.001). Choice for inotropes changed significantly from preoperatively (more levosimendan in Europe) to intraoperatively (more use of epinephrine in both Europe and US). Use of quantitative methods for defining right ventricular function was reported more often from European compared to US centers (p<0.05). Temporary mechanical circulatory support for treatment of right ventricular failure was more often used in Europe. Nitric oxide appears to play a major role only intraoperatively. There were no significant differences in early postoperative complications reported from European vs. US centers. ConclusionsDespite the perioperative practice of care for patients undergoing LVAD implantation differs in several aspects between Europe and the US, there were no perceived differences in early postoperative complications.

Monensin toxicosis in a dog with initial apparent recovery followed by severe relapse

AbstractThis case report describes successful intensive care management of a toxic myopathy in a 7‐month‐old, female, entire springer spaniel secondary to presumed monensin intoxication. The dog was seen chewing a monensin capsule, and was subsequently presented to the local veterinary practice with generalised weakness, ataxia, hypersalivation and pyrexia. Intravenous lipid emulsion‐activated charcoal and intensive fluid therapy were administered. Bloodwork identified a marked increase in serum creatine kinase activity (226,554 iu/L; reference range: 0–400 iu/L). The patient was discharged the following day after initial hospitalisation, with a complete resolution of clinical signs. Five days after exposure, a rapid deterioration required veterinary assessment at the referral hospital. The patient recovered and was discharged after 9 days of hospitalisation. This case report describes recurrence of clinical signs of monensin toxicosis after initial improvement. However, with aggressive emergency care, symptomatic therapy and intense monitoring, a positive outcome was achieved.

Post Operative Management in Intensive Care of Obstructive Jaundice caused by Choledocholithiasis: A Case Report

Introduction: Gallstones are a very common problem in the global population. 10%-25% of affected people may have specific symptoms, and 1%-2% of them may experience major complications.&#x0D; Case presentation: 83-year-old female patient complained of yellow in her eyes and skin. Patients also felt pain in the right upper abdomen. Laboratory examination revealed increased bilirubin serum. Abdominal Ultrasound examination showed Obstruction of the Bilier Ductus caused by a stone at ductus sisticus and sludge of the gallbladder. The patient was diagnosed with Jaundice obstruction caused by obstruction of the bile ducts due to a stone at the ductus sisticus with a history of nephrectomy, Hypertension, and type 2 diabetes. The patient underwent Laparoscopic cholecystectomy, ERCP, and stent biller, After the procedure, the patient was admitted to the intensive care unit.&#x0D; Conclusion: Understanding the patient's comprehensive medical and surgical history is fundamental in understanding the postoperative patient in the intensive care unit. Adequate resuscitation is necessary for good clinical perfusion and physiological stability of the patient.

Workload Perception and Job Satisfaction of Nurses at COVID-19 National Emergency Hospital Wisma Atlet Kemayoran, Jakarta, Indonesia

The COVID-19 pandemic poses a major challenge to healthcare systems around the world. This is due to an imbalance between workload and the number of patients being treated. Nurses have an important role in determining the patient's recovery rate by providing intensive care management to patients, helping to fulfill the basic needs of patients, and collaborating with other health workers. This study aims to describe the workload perception and job satisfaction of nurses encountering the COVID-19 pandemic at the COVID-19 National Emergency Hospital Wisma Atlet Kemayoran (RSDC WAK), Jakarta, Indonesia. This study uses a descriptive study design. The sample of this study has inclusion criteria for nurses who work for the period January – May of 2022. This data collection uses instruments of nursing characteristics, nursing workload perception, and job satisfaction with Maslow’s Hierarchy of Needs. There were 105 samples of nurses chosen by convenience sampling. This study uses univariate (descriptive) statistical tests. The results show that the scale of nurse workload perception was often in the percentage (57.1%) with the most influential indicator being the psychological aspect which not being easy to deal with COVID-19 patients with different characteristics (37.1%) and the physical aspect because of the large amount of work that must be done for patient safety (36.2%). The result of job satisfaction was very satisfactory (57.1%) with the most influential indicator being the attitude of a very good colleague (49.5%) and cooperation between nurses (46.7%). The workload perception and job satisfaction information can be a reference for implementing nursing management strategies that pay attention to health, motivation, and work productivity to maintain the quality of nursing care during a pandemic.

Intensive Care Management of Eclampsia Complicated with Acute Kidney Injury: A Case Report

Background: Pre-eclampsia-related AKI occurs in 21% of all pregnancies, with 4% associated with severe eclampsia. The most common cause of AKI is eclampsia, which affects about 3-5% of pregnancies. Case presentation: The patient came to the hospital with seizures three times at home, whole body seizures, duration 1-2 minutes, and after a seizure, the patient was unconscious. The patient had a seizure in the hospital twice, 5-10 minutes. She has had a history of hypertension during pregnancy (210/112 mmHg). The patient was diagnosed with decreased consciousness due to eclampsia antepartum on Primipara 31-32 weeks of preterm pregnancy on a maintenance dose of MgSO4 regimen + oligohydramnion patient was performed emergency section cesarean. After Termination, the patient was admitted to ICU. The patient was assisted by a mechanical ventilator. Conclusion: Critical care management is necessary for eclampsia with Acute Kidney Injury, adequate initial management, including hemodynamic stabilization, fluid balance, electrolyte correction, and possibly dialysis, is required to reduce morbidity and mortality.

Non-pharmacological interventions to prevent and manage delirium in critically ill children in neonatal and paediatric intensive care units (NICU/PICU): a scoping review protocol

IntroductionDelirium is one of the most common forms of acute cerebral dysfunction in critically ill children leading to increased morbidity and mortality. Prevention, identification and management of delirium is an...

Clinical features and prognosis of toxic epidermal necrolysis requiring intensive care: A retrospective descriptive single-center study

BackgroundToxic epidermal necrolysis (TEN) is the most severe form of drug eruption, necessitating intensive care management in several cases. Although guidelines have been established for diagnosing and treating skin symptoms, few studies have reported on the intensive care management and prognosis of TEN. This study aimed to investigate intensive care for various types of organ failure associated with TEN and their prognoses. MethodsThis retrospective, descriptive, single-center study included patients admitted to our intensive care unit (ICU) for treatment of TEN over a 10-year period. We investigated the participants’ characteristics, organ failure and management, duration of ICU and hospital stay, and prognosis, through the electronic medical and ICU progress records. ResultsThis study enrolled eight patients. Most patients presented with multiple organ failure, and in-hospital mortality was 50%. The median SOFA score at ICU admission was 9.5, and the median maximum SOFA score during ICU stay was 16.0. All patients underwent mechanical ventilation. Renal replacement therapy was administered to five patients. The median length of stay in the ICU was 31.5 days, and the median duration of hospitalization was 87 days. Survivors required long-term hospitalization, and only one patient was discharged home. ConclusionsMost TEN patients admitted to the ICU had multiple organ failure, and poor short- and long-term prognoses.

Outpatient management of established bronchopulmonary dysplasia: An update

As the incidence of infants with bronchopulmonary dyspasia (BPD) has continued to rise, so has their rate of survival. Their medical management is often complex and requires the use of numerous therapies such as steroids, bronchodilators, diuretics and modalities to deliver supplemental oxygen and positive pressure. It also requires multi-disciplinary care to ensure adequate growth and to optimize neurodevelopmental outcomes. This review aims to discuss the most widely used therapies in the treatment of patients with established BPD. The focus will be on ongoing outpatient (post-neonatal intensive care) management of children with BPD. Since many of the mentioned therapies lack solid evidence to support their use, more high quality research, such as randomized controlled trials, is needed to assess their effectiveness using defined outcomes.

Intensive Care Management of Eclampsia with HELLP Syndrome: A Case Report

Background: The incidence of HELLP syndrome is approximately 0.1-1% of all pregnant women and 5.5% of patients admitted to the ICU. Hemolysis, elevated liver enzymes, and thrombocytopenia are the characteristics of HELLP syndrome.&#x0D; Case Presentation: A 38-year-old patient with diagnosed G4P3A0L3 31-32 weeks of preterm pregnancy + eclampsia on MgSO4 regimen, HELLP syndrome + twice previous Sectio cesarean + breech presentation. On physical examination, the general condition was blood pressure 199/103 mmHg. The results of laboratory tests post-op were hemoglobin 7,1 g/dL, leukocytes 15.930, hematocrit 24%, and platelets 38,000. The results of other laboratory tests showed decreased albumin levels (Alb 2,4), increased levels of total bilirubin 14,7, direct bilirubin 10,8 and indirect bilirubin 3,9, increased liver enzyme SGOT 2001 SGPT 513.&#x0D; Conclusion: HELLP syndrome is a threatening clinical problem. Appropriate and adequate management, especially in the Intensive care unit, is needed to prevent severe complications to reduce morbidity and mortality rates in patients with HELLP syndrome.

A Study of the Role of Prognostic Laboratory Parameters among COVID-19 Patients: A Retrospective Cohort Study

Abstract Background: The emergence and spread of the coronavirus disease 2019 (COVID-19) pandemic presents an immense challenge to public health and has resulted in a dramatic loss of human life worldwide. Thus, diagnosis and identification of clinical laboratory parameters associated with the disease become crucial in critical cases, requiring intensive care management. Aim: To investigate clinical laboratory parameters that may be associated with severe or critical COVID-19 disease patients, particularly those requiring intensive care management. Materials and Methods: A retrospective cohort study was conducted at the U. N. Mehta Institute of Cardiology and Research Institute, Ahmedabad, Gujarat. A total of 1460 COVID-19-positive patients (aged 18 years and older) requiring admission to the intensive care unit were selected from April 3 to May 23, 2021, were enrolled, and were diagnostically monitored. Patients were evaluated based on their demographics. A Welsch t-test was used to calculate the progression in the mean difference among inflammatory and/or thromboembolic markers. Results: We analyzed and examined certain laboratory parameters across the timeline and compared survival (Group 1) and nonsurvival (Group 2). All the factors were higher in Group 2 compared to Group 1, except for C-reactive protein-Q (CRP-Q), which decreased in both groups, but in Group 1, there was a further decrease in CRP-Q value as compared to Group 2 on retest day. Conclusion: The results of the current study provide clinical value for prognostic factors associated with COVID-19 and establish the role of laboratory parameters in evaluating disease severity and complications.

Improvement of Predictive Scores in Burn Medicine through Different Machine Learning Approaches.

The mortality of severely burned patients can be predicted by multiple scores which have been created over the last decades. As the treatment of burn injuries and intensive care management have improved immensely over the last years, former prediction scores seem to be losing accuracy in predicting survival. Therefore, various modifications of existing scores have been established and innovative scores have been introduced. In this study, we used data from the German Burn Registry and analyzed them regarding patient mortality using different methods of machine learning. We used Classification and Regression Trees (CARTs), random forests, XGBoost, and logistic regression regarding predictive features for patient mortality. Analyzing the data of 1401 patients via machine learning, the factors of full-thickness burns, patient's age, and total burned surface area could be identified as the most important features regarding the prediction of patient mortality following burn trauma. Although the different methods identified similar aspects, application of machine learning shows that more data are necessary for a valid analysis. In the future, the usage of machine learning can contribute to the development of an innovative and precise predictive score in burn medicine and even to further interpretations of relevant data regarding different forms of outcome from the German Burn registry.

Peripheral VA-ECMO and pericardial drainage connected to the ECMO circuit for cardiac tamponade from blowout rupture: a case report

BackgroundLeft ventricular free wall rupture, particularly the blowout type, is still one of the most lethal complications of myocardial infarction and can cause catastrophic cardiac tamponade. Extracorporeal membrane oxygenation (ECMO) is often used to treat haemodynamic instability due to cardiac tamponade. However, elevated pericardial pressure can cause collapse of the right atrium, resulting in inadequate ECMO inflow and preventing the stabilisation of the circulation. Further, it can interfere with the venous return from the superior vena cava (SVC), increasing the intracranial pressure and reducing cerebral perfusion levels.Case presentationA 65-year-old man was hospitalised for out-of-hospital cardiac arrest. We used ECMO for cardiopulmonary resuscitation. After the establishment of ECMO, transthoracic echocardiography and left ventriculography revealed massive pericardial effusion. The treatment was supplemented with pericardial drainage since ECMO flow was frequently hampered by suction events. However, the blowout rupture led to the requirement of constant drainage from the pericardial catheter. To tend to this leak, we connected the venous cannula of ECMO and the pericardial drainage catheter. The surgery was performed with stable circulation without suction failure of ECMO. During the course of the intensive care management, the neurological prognosis of the patient was revealed to be poor, and the patient was shifted to palliative care. Unfortunately, the patient died on day 10 of hospitalisation.ConclusionWe present a case wherein the combination of pericardial drainage and ECMO was used to maintain circulation in a patient with massive pericardial effusion due to cardiac rupture.

Hyperkalemia in Patients with Type 2 Diabetes Mellitus: Risk Factors and Clinical Outcomes

Hyperkalemia is one of life-threatening electrolyte abnormalities. Diabetes mellitus (DM) is among the diseases in which patients can commonly develop hyperkalemia due to various factors. This study aimed to determine the occurrence of hyperkalemia and potential risk factors that contribute to development of hyperkalemia among type 2 diabetes mellitus (T2DM) patients. This is a single centered retrospective study in all deceased diabetic patients who were previously admitted to Sultan Ismail Petra Hospital, Kelantan state of Malaysia from January 2017 to December 2017 with or without hyperkalemia. A total of 132 patients were studied after screening for eligibility from medical records. Hyperkalemia was defined as potassium level ≥5.5 mEq/L. Univariate and multiple logistic regression analysis were used to identify potential risk factors associated with hyperkalemia. The occurrence of hyperkalemia among T2DM patients was 54.5%. In multivariable analysis, stage 4 CKD (eGFR: 15-29 ml/min/1.73m2) (AOR=0.154, 95%CI=0.003,0.763), use of ARB (AOR=26.269, 95%CI=1.25,548.50) and length of stay (AOR=1.007, 95%CI=1.001,1.013) were the significant risk factors for hyperkalemia. No significant difference between diabetes patients with hyperkalemia (DMHK) group with diabetes patients without hyperkalemia (DMWOHK) group in terms of clinical outcomes. Among diabetic patients with hyperkalemia, the mean time from development of hyperkalemia until death was 99.92±119.07 hours. In conclusion, this study shows that hyperkalemia is common among T2DM patient in our study setting. Although a number of factors may contribute to the high occurrence of hyperkalemia, the use of ARB, advanced CKD at stage 4 and length of stay are major determinants of hyperkalemia occurrence. Aggressive management of hyperkalemia may be beneficial as to prevent significant clinical outcomes requiring intensive care management and cardiac problem lead to death.