Analysis of Electrolyte Levels During the PreCardiac Arrest Period in Hospitalized Patients Aaron Rhee1, Soumya Vijayaleskshmy2, Billal Tokhi2, Maryem Lodhra2, Roman Zeltser1,2, and Amgad N. Makaryus1,2
1Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, 2Nassau university Medical Center Department of Cardiology
Background Despite advances in cardiovascular medicine resulting in a significant reduction in cardiovascular mortality, the mortality from in-hospital cardiac arrest remains high with an incidence of up to 290,000 per year.1 Electrolyte abnormalities involving potassium, magnesium, and calcium are known to contribute to arrhythmogenesis, including cardiac arrest.2 The Belgian Cerebral Resuscitation study group commented on hypokalemia and hypomagnesemia seen in the post-resuscitation period in out-of-hospital cardiac arrest cases.3 However, there is a dearth of studies on the electrolyte status prior to the occurrence of cardiac arrest in hospitalized patients. In this study, we aim to assess for pre-arrest electrolyte abnormalities among in-hospital cardiac arrest patients.
Hypothesis
Conclusions
Results Patient Characteristics Total # of Patients # Excluded Patients (labs > 24 hours prior, hemolysis)
131
Total # of Patients Analyzed Average Age Average BMI
94 69.83 27.85
CAD HFrEF COPD Asthma CKD-3 or above Liver Disease Cancer
22.69% 15.13% 15.13% 7.56% 25.21% 11.76% 21.85%
Prior Documented History
37
Electrolyte Abnormality Total % (hyper-, hypo-) Sodium (n=94)
32.98% (19.15%, 13.83%)
Electrolyte imbalances will precede a significant percent of in-hospital cardiac arrest cases.
Potassium (n=94)
15.96% (7.45%, 8.51%)
Calcium (n=94)
17.02% (8.51%, 8.51%)
Design & Methods
Magnesium (n=57)
52.63% (40.35%, 12.28%)
Phosphate (n=53)
73.58% (33.96%, 39.62%)
This study is a retrospective analysis of data that was obtained via EMR. The subjects are adults over the age of 21. Data includes patient race, gender, diagnosis at admission, and labs up to 24 hours prior to and immediately after in-hospital arrest. The primary variables of interest are electrolyte levels (Na, K, Ca, Mg, Phosphate). Patients were assigned a random number to retain confidentiality, and stripped of identifiers. Data was analyzed and descriptive statistics are presented.
Other Abnormalities Leukocytosis (n=94)
55.32%
Anemia (n=94)
87.23%
Thrombocytopenia (n=94)
29.79%
Hypoalbuminemia (n=75)
89.33%
Magnesium and phosphate abnormalities preceded the majority of in-hospital cardiac arrest cases (52.6% and 73.6% respectively), while sodium, potassium, and calcium abnormalities did not. Other findings including hypoalbuminemia and anemia preceded the vast majority of in-hospital cardiac arrest cases (89.3% and 87.2% respectively).
Though the contributions of electrolyte abnormalities to cardiac arrhythmogenesis and arrest have been welldocumented, there is a dearth of studies on the electrolyte status of patients prior to in-hospital cardiac arrest. In this study, it was found that magnesium and phosphate abnormalities were present in the majority of patients prearrest, while abnormalities in sodium, potassium, and calcium were less common. Hypophosphatemia and hypermagnesemia were the most common among these, and have known associations with cardiac arrhythmia and arrest.4,5 However, hyperphosphatemia has been less wellstudied in such a regard. Recently, it was shown that elevated phosphate levels post-resuscitation from cardiac arrest was independently associated with poor outcomes, which was hypothesized to be related to the degree of ischemic injury to the heart.6 However, the present study indicates that pre-cardiac arrest hyperphosphatemia may also play a role in cardiac injury itself.
Future Directions Future directions include prospective analysis of magnesium and phosphate abnormalities among cardiac in-patients to assess for a causal relationship with cardiac arrest, and to explore the impact of correcting hyperphosphatemia on inhospital cardiac arrest.
References 1. 2. 3. 4. 5. 6.
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