Jongejan, J. (Johanneke) (2016) The role of renal potassium excretion in serum potassium derangements in two different patient groups. thesis, Medicine.
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Abstract
Background Potassium derangements are associated with increased mortality at the intensive care unit (ICU). This study hypothesizes that increased renal loss of potassium plays a role in the development of potassium derangements in patients with traumatic brain injury who received thiopental to induce barbiturate coma (Study A) and in patients who were cooled to therapeutic hypothermia (TH, 33°C) or therapeutic normothermia (TN, 36°C) following an out-of-hospital cardiac arrest (OHCA) (Study B). Methods A single-centre retrospective study was performed. Serum potassium levels were used to determine the incidence of potassium derangements. Potassium balances were calculated from potassium intake and potassium excretion. In Study A three phases were compared; before, during and after thiopental infusion. In Study B the hypothermia/normothermia phase (HT/NT phase) consisted of two calendar days after admission. The post-HT/NT phase consisted of two calendar days following cessation of the HT/NT phase. Results Five patients were included in Study A and 34 patients in Study B (n=16 for TH, n=18 for TN). In Study A, the incidence of hypokalemia was higher during thiopental infusion compared to before and after therapy, respectively, 100%, 60% and 25% (P=0.03). There were no significant differences between potassium balances during thiopental therapy compared to before and after therapy. In Study B, median cumulative potassium administration during the HT/NT phase was 112 (IQR, 65 to 142) mmol in the TH group compared to 36 (IQR, 25 to 54) mmol in the TN group (P<0.001), which resulted in median serum potassium levels of, respectively, 4.2 (IQR, 3.9 to 4.6) mmol/L and 4.0 (IQR, 3.8 to 4.3) mmol/L (P<0.001). Hyperkalemia was more common in the TH group than in the TN group, respectively, in 63% and 11% of patients (P=0.003). There was no difference in median potassium balances between the TH group and the TN group (P=0.145). Conclusion In our study increased renal loss of potassium did not play an evident role in the development of hypokalemia during thiopental infusion and during hypothermia. Since hypokalemia was common during thiopental infusion whereas hyperkalemia was common during and after cooling in the TH group, potassium should be monitored regularly in order to be able to adjust potassium administration. An additional study with increased sample size is necessary to determine the exact role of renal potassium loss in patients who received a barbiturate coma or were cooled to hypothermia/normothermia after hospital admission with an OHCA.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty mentor and Nijsten, M.W. and Additional mentor and Hessels, L. MD/PhD Student and Location Department of Critical Care, University Medical Cen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2428 |
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