Investigation of the physician response to extreme values report for hyperkalemia: Practical cooperation with outpatient service

Abstract

Introduction: Severe hyperkalemia contains risk of cardiac arrest of requiring early treatment. Our hospital sets serum potassium level exceeding 6.0 mmol/L as extreme values, and it is announced immediately to the attending physician. In this study, we investigated the response of physicians to reports and the adequacy of the current reporting system. Methods: The subjects were 131 outpatients of one-year period with hyperkalemia extreme values. We investigated the response of physicians, hyperkalemia triggers and previous treatment, emergency treatment, electrocardiographic findings, potassium level, and potassium changes. Results: Chronic kidney disease, excessive potassium intake, and the medicament side effects accounted for 80% of trigger. 20 patients required emergency procedures. Most of the patients who were treated emergently showed exceed 7.0 mmol/L or elevated above 1.5 mmol/L. When we announced hyperkalemia to the physician, eight patients had already left the hospital. Six of eight patients responded by telephone, and one of six patient required emergency treatment. Six of 29 who required electrocardiography indicated 2.0 mmol/L higher level of potassium changes. Moreover, by the analyses of biochemical items, it was revealed that the urea nitrogen changes and the creatinine changes were useful to evaluate emergent treatment requirement. Conclusions: The hyperkalemia extreme values reporting in the outpatient were evaluated to be useful by the response of physicians. For the prediction of the patients who required emergency treatment, it was necessary to fix hyperkalemia extreme values report procedure.