Hyperkalemia in the Outpatient Department.

Introduction: Hyperkalemia is defined as a serum potassium concentration of >5.5 Meq/L in adults.1 It is a common metabolic disorder that can lead to hemodynamic instability, neurologic sequelae, and fatal arrhythmias. The incidence of hyperkalemia has been reported to range from 2.6% to 3.2% in the United States.2,3 A study in Canada showed an incidence of 2.6% of emergency department visits and 3.5% of hospital admissions.4. Aim: We had undertaken this study to determine the prevalence of hyperkalemia in the Geriatric Outpatient Department and to ascertain the underlying factors resulting in an elevated potassium value. Materials and Methodology: This was a retrospective study. The charts of patients over the age of sixty years, who presented in the OPD setting with high potassium levels over a fifteen day period (July 1st to 31st 2019), were studied. Other parameters like age, gender, comorbidities, medications, diet, severity of hyperkalemia, investigations done, treatment given and follow up were also collated in Epidata and analysed with SPSS. Results: Of the total of fifty four patients with hyperkalemia, thirty two were males (59.26%), forty two (77.78%) were diabetic, forty three (79.63%) had hypertension, twenty (37.04%) had chronic kidney disease, eighteen patients (33.33%) had ischemic heart disease, nine (16.67%) had heart failure, five (9.2%) had cerebrovascular disease, four (7.41%) had malignancy, one (1.85%) had peripheral vascular disease and 77% had other comorbidities including hypothyroidism, obstructive airway disease etc. Of all the comorbidities, hypertension was significantly associated with hyperkalemia (p 0.04). Five patients (9.26%) were on angiotensin converting enzyme inhibitors, eight (14.81%) were on Angiotensin receptor blockers, twenty eight (51.85%) patients were on beta blockers, and eleven (20.37%) patients were on diuretics. Thirty five patients (64.81%) were on other antihypertensives including Calcium channel and alpha blockers. The use of diuretics was also significant (p value 0.043). Thirty five patients (64.81%) were on more than five drugs. Of the patients with hyperkalemia - mild (5- 5.5mg/dl) hyperkalemia was seen in 38 patients (70.37%), fourteen patients (25.93%) had moderate hyperkalemia (5.6-6.0mg/dl) and two (3.70%) patients had severe hyperkalemia (6.1-6.5mg/dl) Two (3.70%) patients were given salbutamol nebulisations; five patients (9.26%) were given dextrose with insulin infusion, five patients (9.26%) were given Inj calcium gluconate IV and eleven patients (20.37%) were given oral resins (polystyrene sulphonate). 12 patients (22%) were treated in the OPD, and all of them when followed up, had normal potassium levels. Two patients required admission. Conclusion: Of the patients who had come to the OPD with hyperkalemia, the majority were males. had diabetes mellitus and hypertension. A majority of the patients were on beta blockers (51%) A majority of patients had mild hyperkalemia (70%), and the offending drug (if any) was discontinued and they were given dietary advice, [ABSTRACT FROM AUTHOR]