• Adam J Singer, Henry C Thode, and W Frank Peacock.
• Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, United States of America. Electronic address: adam.singer@stonybrook.edu.
• Am J Emerg Med. 2020 Nov 1; 38 (11): 2361-2364.

BackgroundHyperkalemia (HK) is common and associated with mortality. Our purpose was to determine if the rapid correction of elevated serum potassium level (K+) was associated with reduced mortality in emergency department (ED) patients.MethodsDesign: We reviewed the electronic medical records (EMR) of ED patients with HK (K+ ≥ 5.5 mEq/L) from 10/2016-10/2017.SettingLarge, academic ED.ParticipantsAdult ED patients presenting with hyperkalemia. Main outcomes and measures: The main outcome was in-hospital mortality. We compared outcomes of patients whose K+ normalized (dropped below 5.5 mEq/L) with those whose K+ did not normalize using chi-square and multivariate analyses to determine the associations between predictor variables and outcomes.ResultsFrom 114,977 ED visits, 1033 patients (0.9%, 95%CI 0.85-0.95%) had HK. Their mean (SD) age was 60 (26) years and 58% were male. Of these, 884 had a second K+ measured within a median (IQR) of 5 (3-8) hours. Mortality and admission rates were higher in patients with HK vs. those with normal K+ (8.5% vs. 0.8%, P < 0.001 and 80% vs. 39%, P < 0.001, respectively). Mortality was lower in patients whose HK normalized compared with those whose K+ remained elevated (6.3% vs. 12.7%, P = 0.001). After adjusting for age, creatinine, comorbidities, and initial K+, normalization of K+ was associated with reduced mortality (OR 0.47, 95%CI 0.28 to 0.80).ConclusionsNormalization of K+ during the ED stay in patients with HK is associated with a 50% mortality reduction. Efforts to rapidly identify and treat HK in the ED are needed.Copyright © 2019 Elsevier Inc. All rights reserved.

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