Hiperpotasemi ile acil servise gelen hastaların ilk tedavi yöntemleri ve tedavi komplikasyonlarının değerlendirilmesi
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Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Acil serviste hiperpotasemi saptanan hastalara güncel hiperpotasemi tedavi
algoritmasına göre tedavi yapılmaktadır. Hiperpotasemi tedavisi yapılırken potasyumdaki
düşme miktarının hastanın özgeçmişine, kullandığı ilaçlara, verilen tedaviye göre oluşan
farklılıklar araştırıldı. Çalışmanın diğer amacı tedavi amacıyla verilen insülin sonrasında
kan şekeri düşmesini etkileyen faktörler araştırıldı.
Yöntem: Çalışmaya Necmettin Erbakan Üniversitesi Meram tıp fakültesi acil
servisine Mart 2021-Mart 2022 tarihleri arasında başvuran hiperpotasemisi olan 154 hasta
dâhil edildi. Hiperpotasemi ile acil servise gelen hastaların tedavi öncesi ve sonrası K+ daki
düşme miktarı 1 mg/dl’den fazla olanlar ile 1 mg/dl’den az olanlar olarak iki gruba ayrıldı.
Çalışmanın diğer amacı ise tedavi sonrası gelişen kan şekerinin düşüp düşmemesine göre
iki gruba ayrıldı. Hastaların yaş, cinsiyet, kullandıkları ilaçlar, komorbiditeleri, verilen
tedaviler, laboratuar sonuçları, başvuru şikâyetleri, EKG bulguları, hastane yatış süreleri,
acil servis tanıları ve hastane sonlanımları kaydedildi. Gruplar arasında istatistiksel
karşılaştırma yapıldı.
Bulgular: Hiperpotasemi saptanan ve çalışmaya alınan hastaların verilen tedavi ile
K+
’u 1 mg/dl’den fazla düşenler 75(%48,7) hasta olarak bulundu. K+ düşüşü 1 mg/dl’den
az olan 79(%48,7) hasta olarak bulundu. Hastaların tedavi sonrası parmakucu kanşekeri
sonuçlarına göre kanşekeri düşen 50(%32,5) hasta ve kanşekeri düşmeyen 104(%67,5)
hasta olarak bulundu. Hastane içi mortaliteye bakıldığında K+
1 mg/dl’den fazla düşüşü
olan 31(%41,3) hasta tespit edildi. K+’un 1 mg/dl’den fazla düşen hastalarda sadece insülin
kullanılma oranı K+’u 1mg/dl’den daha az düşen hastalara göre istatistiksel anlamlı yüksek
bulundu(p<0,001). K+
1 mg/dl’den fazla düşen hastalarda hemodiyaliz yapılma oranı K+
’u
1 mg/dl’den az düşen hastalara göre istatistiksel anlamlı yüksek bulundu(p₌0,006). K+
’u 1
mg/dl’den fazla düşen hastalardaki insülin dozu K+’u 1 mg/dl az düşen hastalara göre
istatistiksel anlamlı yüksek bulundu(p₌0,015). K+
’u 1 mg/dl’den fazla düşen hastalardaki
çoklu tedavi kullanım oranı K+’u 1 mg/dl az düşen hastalara göre istatistiksel anlamlı fark
bulunmadı(p₌0,307).
iii
Kan şekeri düşen hastalarda sadece insülin alma oranı kanşekeri düşüşü olmayan
hastalara göre kıyaslandığında istatistiksel anlamlı yüksek tespit edildi(p<0,001). Kan
şekeri düşmeyen hastalarda 5/1 oranında glikoz/insülin kullanımı oranı kanşekeri düşenlere
göre istatistiksel anlamlı yüksek bulundu(p=0,001). Kan şekeri düşen hastaların 3/1 ve 4/1
glikoz/insülin kullanım oranı kan şekeri düşmeyen hastalara göre kıyaslandığında
istatistiksel anlamlı farklılık tespit edilmedi(3/1 p=0,055)(4/1 p=0,577).
Sonuç: Çalışmamızda tedavi sonrası K+’daki düşme miktarı 1mg/dl’den fazla olan
hastaların 1 mg/dl’den daha az düşen hastalara göre istatistiksel anlamlı olacak şekilde
daha fazla hemodiyaliz alma oranına sahiptiler. Hastalara verilen diğer tedavilerde anlamlı
fark olmadı. Hastane içi mortalite oranı K+
’u 1 mg/dl’den fazla düşenlerde K+’u 1
mg/dl’den az düşenlere göre kıyaslandığında istatistiksel anlamlı yüksek saptandı.
Kan şekeri düşen hastalarda sadece insülin kullanımı oranı kan şekeri düşmeyen
hastalara göre istatistiksel anlamlı yüksek bulundu. Kan şekeri düşmeyen hastalarda 5/1
oranında g/i kullanım oranı kan şekeri düşen hastalara göre kıyaslandığında istatistiksel
anlamlı yüksek bulundu. Sadece insülin verilme tedavisi haricinde insülinle beraber glikoz
verilme oranı kan şekeri düşen ve düşmeyen hastalar arasında kıyaslandığında anlamlı
istatistiksel fark saptanmadı. İnsülin dozu arttıkça potasyumun düşmesinde önemli rol
oynadığı glikoz/insülin oranındaki değişiklikler sanıldığının aksine kanşekeri düşüklüğüne
sebep olmamakta ancak yinede kan şekeri takibi yapılması gerektiği düşünülmüştür.
Introduction and purpose: Patients who are found to have hyperkalemia in the emergency department are treated according to the current hyperkalemia treatment algorithm. In this study, During the treatment of hyperkalemia, the differences in the amount of decrease in potassium according to the patient's history, the drugs used, and the treatment given were investigated. The other aim of the study was to investigate the factors affecting the decrease in blood sugar after insulin given for treatment. Methods: The study included 154 patients with hyperkalemia who applied to the emergency department of Necmettin Erbakan University Meram Faculty of Medicine between March 2021 and March 2022. Patients who came to the emergency department with hyperkalemia were divided into two groups as those with a decrease in K+ more than 1 mg/dl before and after treatment and those with less than 1 mg/dl. Based on the other purpose of the study, they were divided into two groups according to whether the blood sugar developed after the treatment decreased or not. Age, gender, drugs used, comorbidities, treatments given, laboratory results, admission complaints, ECG findings, length of hospital stay, emergency room diagnoses and hospital outcomes of the patients were recorded. Statistical comparison was made between the groups. Findings: The number of patients who were found to have hyperkalemia and were included in the study, whose K+ decreased more than 1 mg/dl with the treatment given, was found to be 75 (48.7%). There were 79 (48.7%) patients whose K+ decrease was less than 1 mg/dl.According to the results of the fingertip blood glucose values of the patients after the treatment, the number of patients with decreased blood glucose was 50 (32.5%), and the number of patients who did not decrease was 104 (67.5%). Considering the inhospital mortality, 31 (41.3%) patients with a K+ decrease of more than 1 mg/dl were detected. The rate of using only insulin in patients with a K+ decrease of more than 1 mg/dl was found to be statistically significantly higher than in patients with a K+ decrease of less than 1mg/dl (p<0.001).The rate of hemodialysis in patients with a K+ decrease of more than 1 mg/dl was found to be statistically significantly higher than in patients with a K+ decrease of less than 1 mg/dl (p₌0.006).The insulin dose given in the treatment was found to be statistically significantly higher in patients whose K+ decreased by more than 1 mg/dl compared to the patients whose K+ decreased by 1 mg/dl (p₌0.015).There was no statistically significant difference in the rate of multiple therapy use in patients whose K+ decreased by more than 1 mg/dl compared to patients whose K+ decreased by 1 mg/dl (p₌0.307). The rate of using only insulin in patients with low blood glucose levels was found to be statistically significantly higher when compared to patients without blood glucose decrease (p<0.001). The rate of glucose/insulin use at the rate of 5/1 in patients whose blood sugar did not decrease was found to be statistically significantly higher than those whose blood sugar decreased (p=0.001). When the 3/1 and 4/1 glucose/insulin usage ratios of the patients with low blood sugar were compared with the patients whose blood glucose did not decrease, no statistically significant difference was found (3/1 p=0.055)(4/1 p=0.577). v Results: In our study, patients with a decrease in K+ more than 1 mg/dl after treatment had a statistically significant higher rate of hemodialysis than patients with a decrease of less than 1 mg/dl. There was no significant difference in other treatments given to the patients. The in-hospital mortality rate was found to be statistically significantly higher in those with a K+ decrease of more than 1 mg/dl compared to those with a K+ decrease of less than 1 mg/dl. The rate of using only insulin in patients whose blood sugar decreased was found to be statistically significantly higher than in patients whose blood glucose did not decrease. In patients whose blood sugar did not decrease, the ratio of 5/1 g/i use was found to be statistically significantly higher when compared to the patients whose blood sugar decreased. When the rate of insulin-only treatment and glucoseadministered treatment with insulin was compared between the patients whose blood sugar decreased and those whose blood sugar did not decrease, no statistically significant difference was found.It was thought that the increase in insulin dose played an important role in the decrease of potassium, the changes in the glucose/insulin ratio did not cause low blood sugar contrary to what was believed, but blood glucose monitoring should still be done.
Introduction and purpose: Patients who are found to have hyperkalemia in the emergency department are treated according to the current hyperkalemia treatment algorithm. In this study, During the treatment of hyperkalemia, the differences in the amount of decrease in potassium according to the patient's history, the drugs used, and the treatment given were investigated. The other aim of the study was to investigate the factors affecting the decrease in blood sugar after insulin given for treatment. Methods: The study included 154 patients with hyperkalemia who applied to the emergency department of Necmettin Erbakan University Meram Faculty of Medicine between March 2021 and March 2022. Patients who came to the emergency department with hyperkalemia were divided into two groups as those with a decrease in K+ more than 1 mg/dl before and after treatment and those with less than 1 mg/dl. Based on the other purpose of the study, they were divided into two groups according to whether the blood sugar developed after the treatment decreased or not. Age, gender, drugs used, comorbidities, treatments given, laboratory results, admission complaints, ECG findings, length of hospital stay, emergency room diagnoses and hospital outcomes of the patients were recorded. Statistical comparison was made between the groups. Findings: The number of patients who were found to have hyperkalemia and were included in the study, whose K+ decreased more than 1 mg/dl with the treatment given, was found to be 75 (48.7%). There were 79 (48.7%) patients whose K+ decrease was less than 1 mg/dl.According to the results of the fingertip blood glucose values of the patients after the treatment, the number of patients with decreased blood glucose was 50 (32.5%), and the number of patients who did not decrease was 104 (67.5%). Considering the inhospital mortality, 31 (41.3%) patients with a K+ decrease of more than 1 mg/dl were detected. The rate of using only insulin in patients with a K+ decrease of more than 1 mg/dl was found to be statistically significantly higher than in patients with a K+ decrease of less than 1mg/dl (p<0.001).The rate of hemodialysis in patients with a K+ decrease of more than 1 mg/dl was found to be statistically significantly higher than in patients with a K+ decrease of less than 1 mg/dl (p₌0.006).The insulin dose given in the treatment was found to be statistically significantly higher in patients whose K+ decreased by more than 1 mg/dl compared to the patients whose K+ decreased by 1 mg/dl (p₌0.015).There was no statistically significant difference in the rate of multiple therapy use in patients whose K+ decreased by more than 1 mg/dl compared to patients whose K+ decreased by 1 mg/dl (p₌0.307). The rate of using only insulin in patients with low blood glucose levels was found to be statistically significantly higher when compared to patients without blood glucose decrease (p<0.001). The rate of glucose/insulin use at the rate of 5/1 in patients whose blood sugar did not decrease was found to be statistically significantly higher than those whose blood sugar decreased (p=0.001). When the 3/1 and 4/1 glucose/insulin usage ratios of the patients with low blood sugar were compared with the patients whose blood glucose did not decrease, no statistically significant difference was found (3/1 p=0.055)(4/1 p=0.577). v Results: In our study, patients with a decrease in K+ more than 1 mg/dl after treatment had a statistically significant higher rate of hemodialysis than patients with a decrease of less than 1 mg/dl. There was no significant difference in other treatments given to the patients. The in-hospital mortality rate was found to be statistically significantly higher in those with a K+ decrease of more than 1 mg/dl compared to those with a K+ decrease of less than 1 mg/dl. The rate of using only insulin in patients whose blood sugar decreased was found to be statistically significantly higher than in patients whose blood glucose did not decrease. In patients whose blood sugar did not decrease, the ratio of 5/1 g/i use was found to be statistically significantly higher when compared to the patients whose blood sugar decreased. When the rate of insulin-only treatment and glucoseadministered treatment with insulin was compared between the patients whose blood sugar decreased and those whose blood sugar did not decrease, no statistically significant difference was found.It was thought that the increase in insulin dose played an important role in the decrease of potassium, the changes in the glucose/insulin ratio did not cause low blood sugar contrary to what was believed, but blood glucose monitoring should still be done.
Açıklama
Anahtar Kelimeler
Hiperpotasemi, Kan şekeri düşüklüğü, Acil servis, Hyperkalemia, Hypoglycemia, Emergency Service
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Musab, G. (2022). Evaluation of the first treatment methods and treatment complications of patients coming to the emergency department with hyperkalemia. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
