Comparison of intravenous versus enteral supplemental potassium in hypokalemia in patients postcardiac care pediatric cardiac intensive.

Hypokalemia is frequently seen in daily clinical practice in a pediatric cardiac intensive care unit (PCICU). It is a strong independent predictor of mortality in patients with heart failure. Therefore, a fast potassium replacement therapy is of fundamental importance in the treatment of hypokalemia. Although intravenous potassium replacement (IVPR) due to hypokalemia is the preferred route in most intensive care settings, associated with known security risks and can lead to arrhythmias, cardiac arrest and death if administered inappropriately. Enteral potassium replacement (EPR) with its superior safety profile, may be a better alternative to IVPR.

   

The primary outcome IVPR compare the efficacy and RPE for the treatment of hypokalemia. The secondary outcome measures include a comparison of adverse effects (hyperkalemia, diarrhea, gastrointestinal bleeding, nausea and vomiting) after RPE and IVPR and a comparison of the number of doses is required to achieve resolution of hypokalemia per episode hypokalemia.

   

The Enteral Versus Intravenous Potassium additional trial was designed as a randomized controlled trial, not blinded, with both arms by physicians at the Aga Khan University (Karachi, Pakistan). Intervention arms will be blogging at random alternate weeks for IVPR and EPR. Recruited patients receive treatment accordingly. For analysis, we use the percentage change in the levels of serum potassium in mEq/L after each event of replacement of potassium in both arms as an end point to compare the efficacy and RPE for the treatment IVPR of hypokalemia.

Mortality, and cardiovascular events with respect to urinary sodium and potassium excretion

The optimal range of sodium intake with respect to cardiovascular health remains controversial.

 

The Canadian and multinational scientists from 17 countries obtained morning fasting urine samples from 101,945 people (24-hour sodium and potassium excretion). They examined the association between urinary Na+ and K+ excretion and the relationship with respect to outcome (death) and major cardiovascular events.

 

Estimated average sodium and potassium excretion was 4.93 gr and 2.12 gr per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3,317 participants. As compared with an estimated sodium excretion of 4 - 6 gr per day, a higher estimated sodium excretion (>/= 7 gr per day) was associated with an increased risk of the composite outcome, as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension, with an increased risk at an estimated sodium excretion of 6 gr or more per day. As compared with the reference range, an estimated sodium excretion that was below 3 gr per day was also associated with an increased risk of the composite outcome. As compared with an estimated potassium excretion that was less than 1.50 gr per day, higher potassium excretion was associated with a reduced risk of the composite outcome.

 

In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 gr per day and 6 gr per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 gr per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events.