School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.
Department of Endocrinology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Int J Clin Pract. 2021 Aug;75(8):e14315. doi: 10.1111/ijcp.14315. Epub 2021 Jun 20.
Incidence of hypokalemia during the management of diabetic ketoacidosis (DKA) is high despite detailed potassium replacement guidelines in its treatment.
We aimed to find the role of pH-adjusted potassium (pH ) in the development of hypokalemia, and their mutual impact on patient outcomes during DKA management.
Adult DKA patient's admission data of preceding 3 years (2015-2017) were retrospectively clerked. Outcomes of interest were time to develop hypokalemia and to terminate emergency department (ED) care (hours), severity of hypokalemia and hospitalisation length (days). Linear regression was used to determine significant associations/predictors.
The study was concluded on 85 patients. Hypokalemia was observed in nearly 3/4 of all admissions and occurred by the time of ED care termination. Each 1 mmol/L increase in pH significantly (a) reduced the degree of hypokalemia by 0.07 mmol/L, (b) delayed time to develop hypokalemia by 4.58 hours, (c) and reduced the ED care time by 1.28 hours. Arterial pH was the other factor significantly delaying time to develop hypokalemia (36.25 hours) and facilitating early discharge from ED (13.86 hours). Moreover, each 1 mmol/L reduction in the degree of hypokalemia increased hospitalisation length by 1.86 days. Though significant, acute kidney injury negligibly increased hospitalisation length by 0.01 days.
pH-adjusted potassium shall be used as a marker for hypokalemia and to initiate potassium replacement instead of measured serum potassium in DKA. Utilising pH will help to avoid hypokalemia, reduce its severity and shorten ED care which will subsequently reduce hospitalisation length. We expect pH to improve pharmacoeconomics in the future.
尽管糖尿病酮症酸中毒（DKA）的治疗中有详细的钾补充指南，但在治疗过程中仍会发生低钾血症。
我们旨在探讨 pH 调整的钾（pH）在低钾血症发展中的作用，以及它们在 DKA 管理过程中对患者结局的相互影响。
回顾性查阅了前 3 年（2015-2017 年）的成人 DKA 患者入院数据。研究目的是观察发生低钾血症的时间和终止急诊科（ED）治疗的时间（小时）、低钾血症的严重程度和住院时间（天）。采用线性回归来确定显著关联/预测因素。
研究共纳入 85 例患者。近四分之三的患者入院时发生低钾血症，且在 ED 治疗结束时发生。pH 值每增加 1mmol/L，（a）低钾血症的严重程度降低 0.07mmol/L，（b）发生低钾血症的时间延迟 4.58 小时，（c）ED 治疗时间减少 1.28 小时。动脉 pH 是另一个显著延迟发生低钾血症时间（36.25 小时）和促进 ED 早期出院时间（13.86 小时）的因素。此外，低钾血症的严重程度每降低 1mmol/L，住院时间延长 1.86 天。尽管具有统计学意义，但急性肾损伤使住院时间仅延长 0.01 天。
在 DKA 中，pH 调整的钾应作为低钾血症的标志物，并启动钾替代治疗，而不是测量血清钾。使用 pH 值将有助于避免低钾血症，降低其严重程度，并缩短 ED 治疗时间，从而缩短住院时间。我们预计 pH 值在未来将改善药物经济学。
