Hasara Shannon, Dubey Jesse, Amatea John, Finnigan Nancy
Department of Pharmacy, Lakeland Regional Health, 1324 Lakeland Hills Blvd., Lakeland, FL 33805, United States of America.
Department of Emergency Medicine, Lakeland Regional Health, 1324 Lakeland Hills Blvd., Lakeland, FL 33805, United States of America.
Am J Emerg Med. 2023 Mar;65:59-64. doi: 10.1016/j.ajem.2022.12.043. Epub 2022 Dec 27.
Hyperkalemia accounts for over 800,000 emergency department (ED) visits in the United States each year, and has been associated with significant morbidity and mortality likely due to fatal cardiac dysrhythmias. Previous studies have demonstrated reductions in mortality when potassium levels are normalized in the ED. Cation exchange resins, such as sodium polystyrene sulfonate (SPS) and sodium zirconium cyclosilicate (SZC), may be administered as a means of definitively eliminating potassium from the body. This practice is based on physician preference and is not supported by high quality data. Two studies evaluating the use of cation exchange resins versus standard treatment in the ED demonstrated reductions in serum potassium levels within two hours of administration; however, there have been no published studies investigating these agents in a head-to-head comparison.
The purpose of this study was to evaluate the efficacy and safety of SPS versus SZC in lowering serum potassium in patients presenting to the ED with hyperkalemia.
This was an institutional review board-approved, retrospective cohort study conducted at a single-site ED. All patients who received medications under the "ED Hyperkalemia Treatment" order set between August 26, 2019 and May 13, 2021 were eligible for inclusion. The primary outcome was the change in serum potassium from baseline to first repeat level following SPS or SZC administration in the ED.
A total of 885 patients were screened with 54 patients in the SPS group and 51 patients in the SZC group included in the final analyses. The mean change in serum potassium from baseline to first repeat level following administration of the cation exchange resin was -1.1 mEq/L for both groups.
Administration of SPS or SZC for the treatment of hyperkalemia in the ED resulted in similar reductions in serum potassium.
高钾血症每年在美国急诊科就诊病例中占80多万例，并且可能由于致命的心律失常而与显著的发病率和死亡率相关。先前的研究表明，在急诊科将血钾水平恢复正常可降低死亡率。阳离子交换树脂，如聚苯乙烯磺酸钠（SPS）和环硅酸锆钠（SZC），可作为从体内彻底清除钾的一种手段给药。这种做法基于医生的偏好，且没有高质量数据支持。两项评估在急诊科使用阳离子交换树脂与标准治疗的研究表明，给药后两小时内血清钾水平有所降低；然而，尚无已发表的研究对这些药物进行直接比较。
本研究的目的是评估SPS与SZC在降低因高钾血症就诊于急诊科的患者血清钾方面的疗效和安全性。
这是一项在单中心急诊科进行的、经机构审查委员会批准的回顾性队列研究。所有在2019年8月26日至2021年5月13日期间根据“急诊科高钾血症治疗”医嘱集接受药物治疗的患者均符合纳入标准。主要结局是在急诊科给予SPS或SZC后，血清钾从基线到首次复测水平的变化。
共筛查了885例患者，最终分析纳入SPS组54例患者和SZC组51例患者。两组在给予阳离子交换树脂后，血清钾从基线到首次复测水平的平均变化均为-1.1 mEq/L。
在急诊科给予SPS或SZC治疗高钾血症，血清钾降低程度相似。
