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Published on: January 16, 2019
Evaluation of a Tiered Potassium Replacement Protocol in Post-Operative Patients Admitted to a Pediatric Cardiac
Taylor A VandenBerg1, Letha A Huang1, Chad A Mackman2
1Department of Pharmacy (TAV, LAH, JLP), AdventHealth for Children, Orlando, FL.
Insights
Our study shows a tiered intravenous potassium protocol effectively treats hypokalemia in pediatric cardiac intensive care unit patients. The protocol resolved low potassium levels with minimal risk of dangerous hyperkalemia.
Area of Science:
- Pediatric Cardiology
- Intensive Care Medicine
- Clinical Pharmacy
Background:
- Post-operative hypokalemia is common in pediatric cardiac intensive care units.
- Existing potassium replacement protocols vary, with limited data on tiered approaches.
Purpose of the Study:
- To assess the efficacy and safety of a novel tiered intravenous potassium replacement protocol.
- To evaluate the protocol's effectiveness in pediatric cardiac surgery patients.
Main Methods:
- Retrospective, single-center observational study.
- Included 23 pediatric patients (up to 18 years) post-cardiac surgery.
- Analyzed 95 hypokalemia episodes (serum potassium ≤ 3.7 mEq/L) and replacement doses.
Main Results:
- A median of one dose resolved hypokalemia across both protocol tiers.
- Two cases (2.1%) of moderate hyperkalemia (serum potassium ≥ 5.5 mEq/L) occurred.
- No hyperkalemia episodes showed ECG abnormalities or required treatment.
Conclusions:
- The tiered protocol effectively resolved hypokalemia.
- Higher replacement thresholds and doses did not lead to significant hyperkalemia.
- This protocol offers a safe and effective option for managing hypokalemia in this population.
Objective:
To evaluate the efficacy and safety of our institution's tiered intravenous potassium replacement protocol in pediatric patients admitted post-operatively to the pediatric cardiac intensive care unit. To our knowledge, this is the only study evaluating the specific parameters of a potassium replacement protocol similar to ours.
Methods:
This retrospective, single-center, observational study evaluated children up to 18 years of age admitted post-operatively to the pediatric cardiac intensive care unit between September 1, 2022 and January 31, 2023 who received 1 or more doses of intravenous potassium per our institutional replacement protocol for a hypokalemic episode (serum potassium concentration less than or equal to 3.7 mEq/L). All patients, hypokalemia episodes, replacement doses, and subsequent serum potassium concentrations were evaluated until post-operative day 5.
Results:
There were 23 patients included with a total of 95 episodes of hypokalemia. For both tiers of the replacement protocol, a median of 1 dose was required to resolve hypokalemia. Two incidences of hyperkalemia (serum potassium greater than or equal to 5.5 mEq/L), 2.1% of total, were proven or suspected to be true, both classified as moderate hyperkalemia. All episodes of hyperkalemia were not associated with ECG abnormalities and did not require treatment.
Conclusions:
Despite utilizing higher serum potassium concentration thresholds for replacement as well as higher maximum dosing than published literature, our protocol was effective at resolving hypokalemia, as defined by our protocol, without leading to significant hyperkalemia.
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