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Hypokalemia Measurement and Management in Patients With Status Asthmaticus on Continuous Albuterol
Courtney Cox1,2, Krishna Patel2, Rebecca Cantu3,2
1Divisions of Critical Care Medicine.
Insights
Continuous albuterol for status asthmaticus in children rarely requires frequent potassium monitoring. This study found few instances of hypokalemia treatment, suggesting fewer lab draws may be safe, reducing costs and patient distress.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Emergency Medicine
- Pediatric Pulmonology
Background:
- Status asthmaticus is a severe asthma exacerbation requiring intensive treatment in children.
- Continuous albuterol infusion is a common therapy for pediatric status asthmaticus.
- Continuous albuterol can lead to hypokalemia, necessitating potassium monitoring.
Purpose of the Study:
- To evaluate the necessity of serial potassium monitoring in pediatric patients with status asthmaticus receiving continuous albuterol.
- To determine if hypokalemia treatment frequency justifies extensive laboratory monitoring.
Main Methods:
- Retrospective analysis of 185 pediatric patients with status asthmaticus treated with continuous albuterol (2017-2019).
- All patients received intravenous fluids with potassium supplementation.
- Primary outcome: hypokalemia treatment frequency relative to potassium lab draws. Secondary outcome: hypokalemia frequency related to albuterol dose and duration.
Main Results:
- 156 patients had an average of 2.7 potassium lab draws each.
- Median lowest potassium level was 3.40 mmol/L; only 13 instances of hypokalemia treatment occurred.
- No significant correlation found between albuterol dose/duration and lowest potassium levels or hypokalemia development.
Conclusions:
- High frequency of potassium laboratory draws in pediatric status asthmaticus patients receiving continuous albuterol.
- Hypokalemia requiring treatment beyond routine fluid supplementation was infrequent.
- Reduced frequency of serial potassium monitoring may be feasible, potentially decreasing healthcare costs, pain, and anxiety.
Objective:
Status asthmaticus is commonly treated in pediatric patients by using continuous albuterol, which can cause hypokalemia. The primary aim of this study was to determine if serial potassium monitoring is necessary by examining treatment frequency of hypokalemia.
Methods:
This retrospective analysis was performed in 185 pediatric patients admitted with status asthmaticus requiring continuous albuterol between 2017 and 2019. All patients were placed on intravenous fluids containing potassium. The primary outcome measure was the treatment of hypokalemia in relation to the number of laboratory draws for potassium levels. The secondary outcome measure was hypokalemia frequency and relation to the duration and initial dose of continuous albuterol.
Results:
Included were 156 patients with 420 laboratory draws (average, 2.7 per patient) for potassium levels. The median lowest potassium level was 3.40 mmol/L (interquartile range, 3.2-3.7). No correlation was found between initial albuterol dose and lowest potassium level (P = .52). Patients with hypokalemia had a mean albuterol time of 12.32 (SD, 15.76) hours, whereas patients without hypokalemia had a mean albuterol time of 11.50 (SD, 12.53) hours (P = .29). Potassium levels were treated 13 separate times.
Conclusions:
The number of laboratory draws for potassium levels was high in our cohort, with few patients receiving treatment for hypokalemia beyond the potassium routinely added to maintenance fluids. Length of time on albuterol and dose of albuterol were not shown to increase the risk of hypokalemia. Serial laboratory measurements may be decreased to potentially reduce health care costs, pain, and anxiety surrounding needlesticks.
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