Uso de calcio por vía intravenosa en urgencias para tratar pacientes con hiperpotasemia e intoxicación por digoxina y su impacto en la evolución a corto plazo

IF 2.6 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica Pub Date : 2024-11-29 DOI:10.1016/j.medcli.2024.10.007

Pere Llorens , María Mataix , Matilde González Tejera , Leticia Serrano , Pablo Herrero-Puente , María Luisa López-Grima , Begoña Espinosa , Francisco Javier Lucas-Imbernón , María Pilar López-Díez , Javier Millán , Pilar Gallardo Rodríguez , Pablo Chico-Sánchez , Patricio Mas , Paula Lafuente , Cristina Calzón Blanco , Òscar Miró

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引用次数: 0

Abstract

Objetives

Patients with digitalis intoxication (DI) and hyperkalaemia are frequently encountered in the emergency department (ED). This alteration may require intravenous (iv) calcium, but its administration has been considered to increase cardiotoxicity and mortality in patients with DI. We studied the effect of iv calcium on mortality and 30-day readmission in patients with hyperkalaemia and DI.

Methods

A retrospective, multicentre, retrospective cohort study including all patients with DI and hyperkalaemia from 2004 to 2023 seen in 6 hospital emergency departments. Two cohorts were created according to iv calcium administration, and demographic, clinical, electrocardiographic and outcome variables (mortality, readmission and combined event at 30 days) were collected.

Results

117 patients with ID and hyperkalaemia were collected and 29% were administered iv calcium. Seventy-eight point 6 percent were women, with a median age of 82.8 years. Cardiological symptoms were present in 57.3%, 47% digestive and 37.6% neurological. Cardiac arrhythmia was present in 86.3%, the most frequent type being slow supraventricular arrhythmia in 76.1%. The presence of cardiological symptoms (76.5% vs. 49.4, P=.007), arrhythmias (97.1% vs. 81.9%, P=.037), and higher levels of creatinine (70.6% vs. 42.2%, P=.005) and serum potassium (94.1% vs. 31.3%, P<.001) was more frequent in the group receiving iv calcium. An association was found between the administration of iv calcium An association was found between calcium administration and the combined event at 30 days (ORa 3.11, 95% CI:1.02-9.53), but this increase was at the expense of more readmissions (ORa 3.58, 95% CI, 1.04-12,33), with no relationship found with mortality at 30 days (ORa 0,75, 95% CI: 0.18-3.09).

Conclusion

Calcium administration in hyperkalaemia and ID is not associated with short-term mortality.

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急诊静脉补钙治疗高钾血症和地高辛中毒患者及其对短期预后的影响。

目的：洋地黄中毒（DI）合并高钾血症是急诊科（ED）的常见病。这种改变可能需要静脉（iv）钙，但它的给药已被认为增加心脏毒性和死亡率的患者DI。我们研究了静脉钙对高钾血症和DI患者死亡率和30天再入院的影响。方法：一项回顾性、多中心、回顾性队列研究，包括2004年至2023年6家医院急诊科的所有DI和高钾血症患者。根据静脉钙给药建立了两个队列，并收集了人口统计学、临床、心电图和结果变量（死亡率、再入院率和30天合并事件）。结果：收集了117例ID合并高钾血症患者，其中29%给予静脉补钙治疗。78.6%是女性，平均年龄为82.8岁。心血管症状占57.3%，消化系统占47%，神经系统占37.6%。心律失常占86.3%，最常见的类型为慢速室上性心律失常（76.1%）。心脏科症状（76.5% vs. 49.4%， P= 0.007）、心律失常（97.1% vs. 81.9%， P= 0.037）、肌酐（70.6% vs. 42.2%， P= 0.005）和血钾（94.1% vs. 31.3%， P）升高。结论：高钾血症和ID患者给予钙与短期死亡率无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medicina Clinica 医学-医学：内科

CiteScore

3.10

自引率

5.10%

发文量

295

审稿时长

22 days

期刊介绍： Medicina Clínica, fundada en 1943, es una publicación quincenal dedicada a la promoción de la investigación y de la práctica clínica entre los especialistas de la medicina interna, así como otras especialidades. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica.