Date of Award

Winter 1-1-2019

Document Type

Dissertation

Degree Name

MPharm Pharmacy Practice

Department

Department of Pharmacy Practice

First Advisor

Dr. Vijayanarayana K

Second Advisor

Dr. Tom Devasia

Abstract

Background: Hyper and hypokalemia is a common ionic imbalance in patient with heart failure. Increased death and hospital stay is common in patients with HF and chronic kidney disease (CKD) who have hypokalaemia. The majority of the intracellular cation is potassium which is necessary to retain a normal charge difference between the intracellular and extracellular spaces. It often happens as a complication of certain diseases or drugs. As hyper or hypokalaemia are potentially hazardous and frequent complication in heart failure patient it is important to identify patients who are at increased risk for hypo and hyperkalaemia. Objectives: The objective of this study was to identify socio-demographic characteristics, etiological factors and risk factors for hypo/ hyperkalaemia in newly diagnosed patients with heart failure. Methods: Heart failure patient details were retrospectively identified from medical records using ICD 10 code I50.22. Ethical Committee approval was obtained before start of the study. Based on the inclusion and exclusion criteria patient’s files was reviewed for demographic information, clinical data, laboratory parameters, medication history and drugs prescribed and was entered in case record forms (CRF). Type, duration, severity of illness and co morbid conditions of the patients were also recorded. Control group were heart failure patients with normal potassium levels. Cases were failure patients developing hyper or hypokalaemia during the treatment. The obtained data was analyzed by using SPSS software using Chi square test and Logistic regression and expressed as odds ratio (OR). Results: Totally, Out of 804 patients details collected retrospectively, 512 were males (63.7%) and 292 (36.3%) patients were females. Hypokalaemia group had 194 patients, 110 were males (56.7%) and 84 (43.3%) patients were females. Likewise, in hyperkalaemia, out of 152 patients, 103(67.8%) were males, females were found to be 49(32.2%). Hyperkalaemia patients having longer duration of hospital stay (8.1±5.5) comparatively than hypokalaemia (7.9±5.7). Digoxin had an associated odds ratio [OR: 1.417; CI: 0.998- 2.012] with the development of hypokalaemia. Spironolactone had an associated odds ratio [OR: 2.101; CI: 1.243-3.551] with the development of hyperkalaemia. Conclusion: Our finding may help to better identify patients with heart failure most likely to benefit from careful monitoring of serum potassium level. Improved vigilance is needed during start of treatment with certain classes of drugs and co-morbid illness.

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