Prevalence, associated factors, management and outcomes of hypokalaemia in hospitalised patients at a South African tertiary centre
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i11.2066Keywords:
hypokalaemia, retrospective cohort study, mortality, AfricaAbstract
Background. Hypokalaemia is a common electrolyte disorder encountered in hospitalised patients and is associated with significant morbidity and mortality. There is a lack of data regarding its prevalence, associated factors, management and outcomes among hospitalised patients in South Africa (SA).
Objectives. To evaluate the prevalence, associated factors, management and risk factors for all-cause mortality in hospitalised adult patients with hypokalaemia at a tertiary centre in SA.
Methods. We conducted a retrospective cohort study of all adult patients admitted with, or who developed, hypokalaemia during hospitalisation in 2019. Hypokalaemia was defined as a serum potassium concentration (K+) <3.5 mmol/L. Based on a sample size calculation, a computer-generated random sample of 245 patients was used.
Results. The period prevalence of hypokalaemia was 6.8% (3 539/52 243). The median (interquartile range) age was 46 (33 - 63) years, and 60% were female. Patients who died had a lower K+ during hospitalisation (3.0 mmol/L v. 3.2 mmol/L, p<0.01). Half of the patients had hypokalaemia on admission. The most common causes were gastrointestinal (37%) and renal (36%) losses. More than half (56.7%) of the patients received no potassium replacement, and of those discharged, only 37.5% were normokalaemic. In-hospital mortality was 16.7%. Only blood pH was associated with in-hospital death (adjusted odds ratio 0.01, 95% confidence interval 0.00 - 0.92, p=0.046). On survival analysis, there was no difference regarding in-hospital death by K+ category (log rank p=0.786).
Conclusion. Although the prevalence of hypokalaemia among adult patients who were hospitalised was found to be low, their in-hospital mortality rate was high. Moreover, the investigations and management of hypokalaemia were frequently found to be inadequate. Therefore, it is imperative for healthcare providers in the hospital setting to enhance their knowledge and management of hypokalaemia. The findings of this study have implications for developing evidence-based guidelines for managing hypokalaemia in SA.
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