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Resuscitative Hyperkalemia in Noncrush Trauma: A Prospective, Observational Study

Robert M. Perkins^*,, Matthew C. Aboudara^*, Kevin C. Abbott^*,, and John B. Holcomb

^* Department of Internal Medicine, Nephrology Service, Walter Reed Army Medical Center, Washington, DC; and US Army Institute of Surgical Research, San Antonio, Texas

Address correspondence to: Dr. Robert M. Perkins, Nephrology Service/Ward 48, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307. Phone: 202-782-6462; Fax: 202-782-0185; E-mail: robert.perkins{at}na.amedd.army.mil

The trauma patient is exposed to physiologic processes and life-saving interventions that predispose to hyperkalemia. Severe elevations in potassium levels subject this compromised patient to additional cardiac risks in the periresuscitative period. Recent advances in the care of the massively traumatized patient may or may not increase the risk for hyperkalemia. This prospective, observational study was undertaken to define the period prevalence of hyperkalemia (plasma potassium level 5.5 mmol/L) in a noncrush trauma population during the initial resuscitative period and to identify potential risk factors for the development of hyperkalemia. A total of 131 patients were studied during the initial 12 h after admission for noncrush trauma. The period prevalence of hyperkalemia was 29.0%. Hyperkalemic patients had dramatic shifts in plasma potassium levels compared with nonhyperkalemic patients. Five patients, all from the hyperkalemic group, died. By multivariate logistic regression analysis, independent risk factors for hyperkalemia were an emergency department plasma potassium level of 4.0 mmol/L or higher (relative risk 3.40; 95% confidence interval 1.17 to 9.84; P = 0.024 versus baseline potassium level <4.0 mmol/L) and transfusion of cell- or plasma-based products (relative risk 10.56; 95% confidence interval 3.62 to 30.78; P < 0.001 per log-transformed unit). The prevalence of hyperkalemia during trauma resuscitation was not reported previously. Given the arrhythmic risks of hyperkalemia, particular caution is necessary with trauma patients who present with plasma potassium levels >4.0 mmol/L and require aggressive transfusion support.

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