DR. Akash THESIS 

ETIOLOGY, INCIDENCE AND OUTCOME OF POTASSIUM ABNORMALITIES IN ICU PATIENTS

INTRODUCTION: 

Claude Bernard wrote that ‘the constancy of the internal milieu is the essential condition to a free and independent life’. Potassium is the most abundant cation in the human body, with total body stores amounting to 50 mmol/kg in adults. Less than 2% of K+ is located extracellularly, and kalemia is maintained in the narrow range of 3.5–5.0 mmol/L.

Potassium (K+) is an important electrolyte that has been proven essential for normal functioning of the cardiovascular system, skeletal muscle, internal organs, and nervous system. The intracellular proportion of K+, which represents more than 98% of the total body K+, controls cell metabolism and the resting membrane potential. Intracellular K+ is essential for excitability and automaticity of myocardial cells and for the normal functioning of other cells. The normal serum K+ level is 3.5 to 4.5 mEq/L.¹ ²An abnormal K+ level predisposes a patient to serious complications, especially cardiac arrhythmia and muscle weakness, which may provoke sudden cardiac arrest and/or respiratory failure. Critically ill patients are at risk for alterations in their serum K+ level. Reduced kidney function, the presence of metabolic acidosis, use of mechanical ventilation, and increases in cell turnover promote K+ accumulation. Certain medications such as insulin, sympathomimetic agents, and diuretics decrease serum K+, while spironolactone, angiotensin-converting enzyme inhibitors, and angiotensin receptor antagonists increase serum K+. Hypokalemia and hyperkalemia can both induce cardiac arrhythmias .³ ⁴

  

AIM

TO FIND OUT ETIOLOGY, INCIDENCE AND OUTCOME OF POTASSIUM ABNORMALITIES IN ICU PATIENTS

OBJECTIVES 

1) To identify the spectrum of potassium abnormalities in ICU patients.

2)To study the clinical and laboratory profile of the spectrum of  potassium abnormalities in ICU patients 

3)To assess the various factors influencing the causation and recovery potassium abnormalities in those patients. 

STUDY DESIGN :

Prospective study design with analysis of factors influencing the outcome of the patients with hypokalemia and hyperkalemia 

INCLUSION CRITERIA

1) Patients above the age of 18 years.

2) Patients with <3.5 and >5 of K+ in ICU.

3) Patients who are willing for study and giving consent for the purpose of study.

EXCLUSION CRITERIA

1) Patients under the age of 18 years

2) Patients/Patients attendants who are not willing for study or not giving consent for the purpose of study

3) Patients without any factors or conditions associated potassium imbalance.

PLACE OF STUDY: Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally.

STUDY PERIOD:   November 2023 - October 2025

STUDY DESIGN: Prospective Observational Qualitative study.

SAMPLE SIZE: Proposed No. of cases to be studied = 60  

CASE PROFORMA

Serial number

Name

Age

Sex

OP/IP number

Place 

Complaints:

Shortness of breath                               

Fever

Chest pain

Palpitations

 Pedal edema

Facial puffiness

Oliguria

Anuria

Muscle weakness 

Generalized weakness. 

 Nausea

vomiting

diarrhea.

PERSONAL HISTORY 

Alcohol history: 

Smoking history:

Appetite:

Bladder and bowel habits:

PAST HISTORY: 

         family history of similar illness

         HIV status                                     

 H.o Diabetes mellitus

 H/o coronary artery disease                                                            

 Hypertension 

 H/o blood transfusions                                                                    

Chronic kidney disease 

Tuberculosis   

GENERAL EXAMINATION 

 Pallor                                                       

 Icterus

 Lymphadenopathy                    

 Clubbing                               

 Cyanosis                                                                    

 Chest AP and Transverse diameters                        

 Elevated JVP

 Facial Puffiness

 Pedal Edema

RESPIRATORY EXAMINATION:

Movements of chest:

Percussion:

Air entry:

Breath sounds:

CARDIOVASCULAR SYSTEM: 

Heart sounds:

 JVP:

 Added sounds:

GASTROINTESTINAL SYSTEM: 

Inspection: Palpation:

Shape of abdomen organomegaly

Umbilicus liver span

Percussion: Auscultation:

Shifting dullness Bowel sounds 

                                           

CENTRAL NERVOUS EXAMINATION:

Higher mental functions:

Motor and sensory system:

Cerebellar functions:

Meningeal signs:

INVESTIGATIONS: 

SERUM ELECTROLYTES

URINARY ELECROLYTES

SERUM OSMOLARITY

ECG 

 

OUTCOMES:

1)  Asymptomatic

2) Symptomatically better

3) Mortality

CONSENT: 

I/WE, relative of the patient have read and understood the information provided in the patient information sheet and have been informed the purpose of the evaluation in the language I understand.

I am aware of the fact that I may not derive any benefit from the evaluation and that I deserve the right to opt out of the study at any point of time.

I willingly agree to participate in this study.

Patients sign/thumb impression:                             witness sign/thumb impression.

Name:                                                                            name:

Date:                                                                               date:

 

Residents sign:

Resident name:

date: 

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