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Potassium Concentration in Initial Fluid Therapy and In-Hospital Mortality of Patients with Diabetic Ketoacidosis.

Authors :
Akira Okada
Hayato Yamana
Kojiro Morita
Yukihito Sato
Satoko Yamaguchi
Kayo Ikeda Kurakawa
Nobuaki Michihata
Hiroki Matsui
Kiyohide Fushimi
Masaomi Nangaku
Toshimasa Yamauchi
Hideo Yasunaga
Takashi Kadowaki
Okada, Akira
Yamana, Hayato
Morita, Kojiro
Sato, Yukihito
Yamaguchi, Satoko
Kurakawa, Kayo Ikeda
Michihata, Nobuaki
Source :
Journal of Clinical Endocrinology & Metabolism; May2021, Vol. 106 Issue 5, pe2162-e2175, 14p
Publication Year :
2021

Abstract

<bold>Context: </bold>Guidelines worldwide recommend potassium replacement of 10 to 40 mmol/L in the initial fluid therapy for patients with diabetic ketoacidosis. However, evidence is lacking as to the association between infused potassium concentration and mortality.<bold>Objective: </bold>We aimed to determine the association between infused potassium concentration and in-hospital mortality.<bold>Methods: </bold>Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified inpatients admitted for treatment of diabetic ketoacidosis from July 2010 to March 2018. Patients with kidney dysfunction or serum potassium abnormalities were excluded. We evaluated the association of the potassium concentration in the total infused solutions in the first 2 days of hospitalization with 28-day in-hospital mortality using multivariable regression analysis with a cubic spline model. We also assessed the association between potassium concentration and occurrence of hyperkalemia.<bold>Results: </bold>We identified 14 216 patients with diabetic ketoacidosis and observed 261 deaths. The quartile cut-points for potassium concentration were 7.7, 11.4, and 16.1 mmol/L. Within the range of approximately 10 to 40 mmol/L, potassium concentration was not associated with occurrence of hyperkalemia or death. Lower potassium concentrations were associated with higher 28-day in-hospital mortality; the odds ratio for patients receiving 8 mmol/L was 1.69 (95% CI, 1.03 to 2.78; reference: 20 mmol/L), and the odds ratio increased monotonically as potassium concentration decreased further.<bold>Conclusion: </bold>Patients receiving potassium replacement at concentrations of 10 to 40 mmol/L had similar in-hospital mortality rates, whereas lower concentrations were associated with higher mortality. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
0021972X
Volume :
106
Issue :
5
Database :
Complementary Index
Journal :
Journal of Clinical Endocrinology & Metabolism
Publication Type :
Academic Journal
Accession number :
150395323
Full Text :
https://doi.org/10.1210/clinem/dgab029