Hyperkalemia in hospitalized patients -: Causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines
Hyperkalemia in hospitalized patients -: Causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines
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DOI：
10.1001/archinte.158.8.917
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发表时间：
1998-04-27
影响因子：
--
通讯作者：
Greenberg, A
中科院分区：
文献类型：
--
作者：
Acker, CG;Johnson, JP;Greenberg, A
背景：高钾血症是一种常见的、潜在威胁生命的疾病。心电图被认为是高钾血症存在的敏感指标。由于治疗高钾血症的操作相对较少，而且其成功程度可以客观评分，我们调查了医生如何处理这种疾病以及他们的处方治疗有多成功。我们还试图通过向治疗医生提供实时的治疗指南来确定是否可以改善治疗。方法：通过回顾实验室记录来确定连续的高钾血症患者。在研究的仅观察阶段，记录人口统计数据、致病原因、心电图发现、使用的治疗方法、对处方指南的遵从性和患者结局。在随后的研究通知阶段，当注意到钾值升高时，治疗建议被发送到患者的病房。结果：在仅观察阶段有127次高钾血症，在通报阶段有115次高钾血症。没有患者死亡或发生危及生命的心律失常。与高钾血症一致的心电图异常仅在14%的发作中观察到。肾功能衰竭(77%)、药物(63%)和高血糖(49%)是导致大多数发作的原因。使用的治疗方法是交换树脂(51%)、胰岛素(46%)、钙(36%)、碳酸氢盐(34%)和沙丁胺醇(4%)。这些药剂也同样有效。血钾水平在6.5 mmol/L或以上的患者首次治疗时间明显短于血钾水平较低的患者(2.1±2.2vs2.8+/-2.4h；P
Background: Hyperkalemia is a common, potentially life-threatening disorder. Electrocardiograms are considered to be sensitive indicators of the presence of hyperkalemia. Since the treatment of hyperkalemia involves relatively few maneuvers and because its success can be objectively scored, we investigated how physicians manage this disorder and how successful their prescribed therapy is. We also sought to determine whether treatment could be improved by providing the treating physicians with therapy guidelines on a real-time basis.Methods: Consecutive patients with hyperkalemia were identified by review of laboratory records. During the observation-only phase of the study, demographic data, contributing causes, electrocardiogram findings, treatments used, compliance with prescribing guidelines, and patient outcome were recorded. During the subsequent notification phase of the study, treatment recommendations were sent to the patient's ward when the elevated potassium value was noted. The same outcome data were collected.Results: There were 127 episodes of hyperkalemia during the observation-only phase and 115 during the notification phase. No patients died or had life-threatening cardiac arrhythmias. Electrocardiographic abnormalities consistent with hyperkalemia were observed in only 14% of episodes. Renal failure (77%), drugs (63%), and hyperglycemia (49%) contributed to most episodes. Treatments used were exchange resin (51%), insulin (46%), calcium (36%), bicarbonate (34%), and albuterol (4%). The agents were equally efficacious. The time to first treatment was shorter in patients with potassium levels of 6.5 mmol/L or more than in patients with lower values (2.1 +/- 2.2 vs 2.8 +/- 2.4 hours; P