Hiperkalemi ile acil servise gelen hastaların, kan gazı ve kan biyokimya tetkiklerinde ki potasyum değerlerinin kıyaslanması
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Tarih
2022
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Acil servise hiperpotasemi ile gelen hastalarda; hiperpotaseminin ölümcül etkileri dikkate alınarak, kısa zamanda hiperkalemi teşhisini koyup tedavi vermek amacıyla hızlı netice veren kan gazı tetkiki ile elde edilen potasyum değeri ile kan biyokimya potasyum değerlerini karşılaştırmak ve kan gazı potasyum değerini biyokimya potasyum değeri yerine kullanılabilip kullanılamayacağını göstermek içi prospektif bir çalışma yaptık.
Gereç ve Yöntemler: 17 Temmuz 2020 – 19 Kasım 2021 tarihleri arasında hiperpotasemi ile gelen 109 hastadan oluşan çalışma grubunda ki hastalardan gelişinde ve tedavi sonrasında eş zamanlı alınarak biyokimya laboratuvarında ve kan gazı analiz cihazında çalışılan potasyum sonuçları prospektif olarak değerlendirildi. İlk başvuruda potasyum seviyesi 5 üzerinde olan hastalar çalışma grubuna alındılar. Çalışma grubunda yer alan 109 hastanın kaydedilen verileri bilgisayar ortamında SPSS (Statical Package for Social Sciences) 18.0 paket programı ile analiz edildi.
Bulgular: Laboratuar potasyum değerleri ile kan gazı potasyum değerleri arasında ki ortalama fark; potasyum değeri 6,5’ten düşük olan hastalarda: 0,32±0,76 mmol/L (% 95 güven aralığı 0,15-0,49 olarak saptandı), potasyum değeri 6,5’ten yüksek olan hastalarda ise 0,74 ± 1,22 mmol/L (% 95 güven aralığı 0,27-1,21 olarak saptandı) olarak tespit edildi. Potasyum seviyesi 6,5’ten düşük ve yüksek iki hasta grubu arasında karşılaştırılan; BUN (Kan üre azotu), kreatin seviyeleri, potasyum (K) seviyesi 6,5’ten yüksek olan grupta anlamlı daha yüksek saptanırken ( BUN: Ortalama değer: K<6,5: 56,20 ± 36,89, K>6,5: 93,12±51,08, p=0,001, kreatin: Ortalama değer: K<6,5: 3,35±3,01 K>6,5: 5,31±4,23, p=0,009); PH (Potasiyel Hidrojen), bikarbonat seviyeleri anlamlı düşük, baz ekstresi seviyesi anlamlı yüksek saptandı (PH: Ortalama değer: K<6,5: 7,28±0,1, K>6,5: 7,20±0,14, p= 0,007, bikarbonat: Ortalama değer: K<6,5:18,01±5,50, K>6,5: 13,67±6,19, p=0,002, baz ekstresi: Ortalama değer K6,5: -6,73±6,99, K>6,5:-13±7,16, P<0,001). Ayrıca karşılaştırmış olduğumuz mortalite oranı da potasyum seviyesi 6,5’ten yüksek olan grupta düşük olan gruba göre anlamlı yüksek tespit edildi (Potasyum seviyesi 6,5’in altında olan grupta mortalite: %25,9, potasyum seviyesi 6,5’ten yüksek olan grupta mortalite % 60,7, p=0,001). Potasyum seviyesi 6,5’ten düşük olan hastalarda kan gazı potasyum ile biyokimya potasyum değerleri arasında pozitif yönde orta derecede korelasyon (r=0,447, p<0,001) tesbit edilirken, potasyum seviyesi 6,5’ten yüksek olan hastalarda ise pozitif yönde çok iyi derecede korelasyon (r=0,713, p<0,001) tesbit edildi.
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Sonuç: Hiperkalemi ile gelen hastaların potasyum seviyesi 6,5’ten düşük olan gruba göre, 6,5’ten yüksek olan grupta; BUN, kreatin, baz ekstresi seviyeleri anlamlı daha yüksek saptanırken Ph, bikarbonat anlamlı düşük tespit edildi. Ayrıca yine potasyum seviyesi 6,5’ten yüksek olan hasta grubunda, hastane içi mortalite istatiksel olarak anlamlı yüksek tespit edildi. Potasyum düzeyi 6,5’ten düşük olan hasta grubunda her iki ölçüm tekniği ile elde edilen sonuçlar arasında orta seviyede; 6,5’ten yüksek olan grupta ise çok iyi derecede korelasyon tespit edildi. Bu sonuçla, özellikle kan gazı potasyum seviyesi 6,5’ten yüksek olan ve hızlı şekilde karar verilip tedavisine başlanması gereken hastaların tedavi yaklaşımında kan gazı potasyum düzeyi dikkate alınıp kılavuz olarak kullanılabilir. Biyokimya potasyum seviyesi hakkında tahminde bulundurabilir. Sonuç itibariyle, hızlı sonuç veren kan gazı potasyum değeri 6,5’ten daha yüksek gelen hastalarda, doktorlara hayatı tehdit eden bir hiperkalemi durumu olduğunu düşündürtebilir ve kan biyokimya potasyum sonucu beklenirken de tedaviyi planlama ve başlama hususunda zaman kazandırmış olur.
Objective: In patients who come to the emergency department with hyperkalemia; Considering the fatal effects of hyperkalemia, we conducted a prospective study to compare the potassium value obtained by blood gas analysis with rapid results and blood biochemistry potassium values in order to diagnose and treat hyperkalemia in a short time, and to show whether the blood gas potassium value can be used instead of the biochemistry potassium value. Material and Methods: Potassium results, which were taken simultaneously from the patients in the study group consisting of 109 patients presenting with hyperkalemia between 17 July 2020 and 19 November 2021, upon arrival and after treatment, and studied in the biochemistry laboratory and blood gas analyzer, were prospectively evaluated. Patients with potassium level above 5 at the first admission They were included in the working group. The recorded data of 109 patients in the study group were analyzed in computer environment with the SPSS (Static Package for Social Sciences) 18.0 package program. Results: The mean difference between laboratory potassium values and blood gas potassium values; in patients with a potassium value less than 6.5: 0.32±0.76 mmol/L (95% confidence interval was found to be 0.15-0.49), in patients with a potassium value higher than 6.5, 0. It was determined as 74 ± 1.22 mmol/L (95% confidence interval was determined as 0.27-1.21). Compared between two patient groups with a potassium level lower than 6.5 and higher; BUN (Blood urea nitrogen), creatinine levels, and potassium (K) levels were found to be significantly higher in the group with higher than 6.5 ( BUN: Mean value: K<6.5: 56.20 ± 36.89, K>6 .5: 93.12±51.08, p=0.001, creatinine: Mean value: K<6.5: 3.35±3.01 F>6.5: 5.31±4.23, p=0.009 ); PH (Potential Hydrogen), bicarbonate levels were found to be significantly lower, and base extract levels were found to be significantly higher (PH: Mean value: F<6.5: 7.28±0.1, F>6.5: 7.20±0.14 , p= 0.007, bicarbonate: Mean value: K<6.5:18.01±5.50, K>6.5: 13.67±6.19, p=0.002, baseline extract: Mean value K6.5 : -6.73±6.99, F>6.5:-13±7.16, P<0.001). In addition, the mortality rate we compared was found to be significantly higher in the group with a potassium level higher than 6.5 compared to the group with a low potassium level (mortality in the group with a potassium level below 6.5: 25.9%, potassium level higher than 6.5) Mortality was 60.7% in the group with the disease, p=0.001). While a moderate v positive correlation (r=0.447, p<0.001) was found between blood gas potassium and biochemistry potassium values in patients with potassium level less than 6.5, a very good positive positive correlation was found in patients with potassium level higher than 6.5. degree of correlation (r=0.713, p<0.001) was determined. Conclusion: Compared to the group with a potassium level lower than 6.5 in the patients presenting with hyperkalemia, in the group with a potassium level higher than 6.5; BUN, creatine, and base extract levels were significantly higher, while Ph, bicarbonate were significantly lower. In addition, in the patient group with potassium levels higher than 6.5, in-hospital mortality was found to be statistically significantly higher. In the patient group with a potassium level less than 6.5, the results obtained with both measurement techniques were moderate; A very good correlation was found in the group with a score higher than 6.5. With this result, blood gas potassium level can be taken into consideration and used as a guide in the treatment approach of patients who have a blood gas potassium level higher than 6.5 and need a quick decision and treatment. Biochemistry can predict the potassium level. As a result, in patients with a rapid-resulting blood gas potassium value higher than 6.5, it may make doctors think that there is a life-threatening hyperkalemia condition, and this may save time in planning and initiating treatment while awaiting the blood biochemistry potassium result.
Objective: In patients who come to the emergency department with hyperkalemia; Considering the fatal effects of hyperkalemia, we conducted a prospective study to compare the potassium value obtained by blood gas analysis with rapid results and blood biochemistry potassium values in order to diagnose and treat hyperkalemia in a short time, and to show whether the blood gas potassium value can be used instead of the biochemistry potassium value. Material and Methods: Potassium results, which were taken simultaneously from the patients in the study group consisting of 109 patients presenting with hyperkalemia between 17 July 2020 and 19 November 2021, upon arrival and after treatment, and studied in the biochemistry laboratory and blood gas analyzer, were prospectively evaluated. Patients with potassium level above 5 at the first admission They were included in the working group. The recorded data of 109 patients in the study group were analyzed in computer environment with the SPSS (Static Package for Social Sciences) 18.0 package program. Results: The mean difference between laboratory potassium values and blood gas potassium values; in patients with a potassium value less than 6.5: 0.32±0.76 mmol/L (95% confidence interval was found to be 0.15-0.49), in patients with a potassium value higher than 6.5, 0. It was determined as 74 ± 1.22 mmol/L (95% confidence interval was determined as 0.27-1.21). Compared between two patient groups with a potassium level lower than 6.5 and higher; BUN (Blood urea nitrogen), creatinine levels, and potassium (K) levels were found to be significantly higher in the group with higher than 6.5 ( BUN: Mean value: K<6.5: 56.20 ± 36.89, K>6 .5: 93.12±51.08, p=0.001, creatinine: Mean value: K<6.5: 3.35±3.01 F>6.5: 5.31±4.23, p=0.009 ); PH (Potential Hydrogen), bicarbonate levels were found to be significantly lower, and base extract levels were found to be significantly higher (PH: Mean value: F<6.5: 7.28±0.1, F>6.5: 7.20±0.14 , p= 0.007, bicarbonate: Mean value: K<6.5:18.01±5.50, K>6.5: 13.67±6.19, p=0.002, baseline extract: Mean value K6.5 : -6.73±6.99, F>6.5:-13±7.16, P<0.001). In addition, the mortality rate we compared was found to be significantly higher in the group with a potassium level higher than 6.5 compared to the group with a low potassium level (mortality in the group with a potassium level below 6.5: 25.9%, potassium level higher than 6.5) Mortality was 60.7% in the group with the disease, p=0.001). While a moderate v positive correlation (r=0.447, p<0.001) was found between blood gas potassium and biochemistry potassium values in patients with potassium level less than 6.5, a very good positive positive correlation was found in patients with potassium level higher than 6.5. degree of correlation (r=0.713, p<0.001) was determined. Conclusion: Compared to the group with a potassium level lower than 6.5 in the patients presenting with hyperkalemia, in the group with a potassium level higher than 6.5; BUN, creatine, and base extract levels were significantly higher, while Ph, bicarbonate were significantly lower. In addition, in the patient group with potassium levels higher than 6.5, in-hospital mortality was found to be statistically significantly higher. In the patient group with a potassium level less than 6.5, the results obtained with both measurement techniques were moderate; A very good correlation was found in the group with a score higher than 6.5. With this result, blood gas potassium level can be taken into consideration and used as a guide in the treatment approach of patients who have a blood gas potassium level higher than 6.5 and need a quick decision and treatment. Biochemistry can predict the potassium level. As a result, in patients with a rapid-resulting blood gas potassium value higher than 6.5, it may make doctors think that there is a life-threatening hyperkalemia condition, and this may save time in planning and initiating treatment while awaiting the blood biochemistry potassium result.
Açıklama
Anahtar Kelimeler
Hiperkalemi, Kan gazı, Biyokimya, Acil servis, Hyperkalemia, Blood gas, Biochemistry, Emergency department
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Uysal, A. (2022). Hiperkalemi ile acil servise gelen hastaların, kan gazı ve kan biyokimya tetkiklerinde ki potasyum değerlerinin kıyaslanması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
