Get access

Life-threatening drug-associated hyperkalemia: a retrospective study from laboratory signals

Authors

  • Pernelle Noize,

    Corresponding author
    1. CHU de Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, F-31000 Toulouse, France
    2. INSERM, U657, F-33000 Bordeaux, France
    3. CHU de Bordeaux, Service de Pharmacologie, Centre de Pharmacovigilance, F-33000 Bordeaux, France
    • Univ. de Bordeaux, U657, F-33000 Bordeaux, France
    Search for more papers by this author
  • Haleh Bagheri,

    1. CHU de Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, F-31000 Toulouse, France
    2. Univ. de Toulouse, Laboratoire de Pharmacologie Médicale et Clinique, Unité de Pharmacoépidémiologie, U1027, F-31000 Toulouse, France
    3. INSERM, U1027, F-31000 Toulouse, France
    Search for more papers by this author
  • Geneviève Durrieu,

    1. CHU de Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, F-31000 Toulouse, France
    2. Univ. de Toulouse, Laboratoire de Pharmacologie Médicale et Clinique, Unité de Pharmacoépidémiologie, U1027, F-31000 Toulouse, France
    3. INSERM, U1027, F-31000 Toulouse, France
    Search for more papers by this author
  • Françoise Haramburu,

    1. Univ. de Bordeaux, U657, F-33000 Bordeaux, France
    2. INSERM, U657, F-33000 Bordeaux, France
    3. CHU de Bordeaux, Service de Pharmacologie, Centre de Pharmacovigilance, F-33000 Bordeaux, France
    Search for more papers by this author
  • Nicholas Moore,

    1. Univ. de Bordeaux, U657, F-33000 Bordeaux, France
    2. INSERM, U657, F-33000 Bordeaux, France
    3. CHU de Bordeaux, Service de Pharmacologie, Centre de Pharmacovigilance, F-33000 Bordeaux, France
    Search for more papers by this author
  • Patrick Giraud,

    1. Clinique du Pont-de-Chaume, Service de Néphrologie et Médecine Interne, F-82000 Montauban, France
    Search for more papers by this author
  • Michel Galinier,

    1. CHU de Toulouse, Service de Cardiologie Générale et Interventionnelle, F-31000 Toulouse, France
    Search for more papers by this author
  • Jacques Pourrat,

    1. CHU de Toulouse, Service de Néphrologie et Immunologie Clinique, F-31000 Toulouse, France
    Search for more papers by this author
  • Jean-Louis Montastruc

    1. CHU de Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, F-31000 Toulouse, France
    2. Univ. de Toulouse, Laboratoire de Pharmacologie Médicale et Clinique, Unité de Pharmacoépidémiologie, U1027, F-31000 Toulouse, France
    3. INSERM, U1027, F-31000 Toulouse, France
    Search for more papers by this author

P. Noize, Université Bordeaux Segalen, Département de Pharmacologie, Zone Nord Carreire, Bâtiment 1A, Case 36, 146 rue Léo Saignat 33076 Bordeaux Cedex, France. E-mail: pernelle.noize@u-bordeaux2.fr

ABSTRACT

Purpose

Life-threatening hyperkalemia may be induced by drugs and preventable in at-risk patients. This study was designed to describe cases of ‘serious’ drug-associated hyperkalemia.

Methods

Adult subjects with a serum potassium concentration above 6.5 mmol/L detected at admission or during hospital stay in nephrology, cardiology, geriatric, emergency or intensive care units were identified by biology laboratories of hospitals and clinics located in Midi-Pyrenees (southwest France). Patients dialyzed for end-stage kidney disease were excluded. Data were collected from medical files. Hyperkalemia was defined as drug-associated if at least one drug known to increase serum potassium concentration was taken when hyperkalemia occurred (among drugs taken in outpatient care for hyperkalemia detected at admission and among drugs taken in outpatient care and continued at hospital and drugs introduced from admission for hyperkalemia detected during hospital stay).

Results

Of 168 hyperkalemia cases, 102 (60.7%) were classified as drug-associated. They concerned elderly patients (mean age: 76.1 years) often having arterial hypertension and/or cardiac diseases (88.2%). Risk factors, mainly acute kidney failure, were observed in almost all cases (98.0%). Drugs predominantly involved were angiotensin-converting enzyme inhibitors (47.1%), spironolactone (41.2%), angiotensin II receptor antagonists (23.5%) and potassium supplements (23.5%). In 10% of cases, death could be attributed to hyperkalemia.

Conclusions

Laboratory databases allowed an exhaustive identification of hyperkalemia cases. The frequency of drug-related hyperkalemia and their characteristics suggest that treatment with drugs known to increase serum potassium concentration can be inappropriate, especially regarding associations or indications, and is highly risky for predisposed patients. Copyright © 2011 John Wiley & Sons, Ltd.

Get access to the full text of this article

Ancillary