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Diuretic-related hypokalaemia: the role of diuretics, potassium supplements, glucocorticoids and β2-adrenoceptor agonists

Results from the comprehensive hospital drug monitoring programme, Berne (CHDM)

  • Pharmacodynamics
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Abstract

All 5,047 consecutive inpatients admitted to the Internal Medicine Division of a teaching hospital (Zieglerspital, Berne) between 1982 and 1985 were registered in accordance with the CHDM (Comprehensive Hospital Drug Monitoring) questionnaire of adverse drug reactions (ADRs). Of them, 2,439 were treated with at least one potassium losing diuretic. The hospital records of the patients were reviewed with particular regard to serum potassium levels, and on the basis of this evaluation, the patients were assigned to four different diuretic treatment groups, and the incidence of hypokalaemia related to diuretic treatment was estimated. The overall rate of occurrence of hypokalaemia was 21.1% at a serum potassium level <3.5 mmol·1−1, and 3.8% <3.0 mmol·1−1. Hypokalaemia of less than 3.5 mml·1−1 developed 24.9% (217/870) of patients treated with potassium losing diuretics alone; in 19.7% (101/513) treated with potassium losing diuretics in conjunction with potassium substitution, in 15.1% (66/438) treated with a combination of diuretics (potassium losing with potassium sparing), and in 20.0% (12/60) treated with combined diuretics and potassium substitution. Only the differences between the first and the two subsequent groups were statistically significant. The overall incidence of hypokalaemia below 3.0+mmol·1−1 was significantly lower in the patients on combined diuretics without potassium substitution than in the patients on potassium losing diuretics with potassium substitution.

Oral or parenteral administration of glucocorticoids (prednisone 5 to 2,000 mg/d) was a significant risk factor for hypokalaemic events. β2-Adrenoceptor agonists had not effect. The patient's age, sex, renal function and numbers of drugs received were evaluated in a multivariate analysis, in order to take into account their influence on the risk of developing hypokalaemia. The number of drugs above 12 (and, less importantly, female sex) was the main risk factor for this ADR.

The comparison between hypokalaemia and hyperkalaemia in this group of inpatients showed the significance of reduced renal function in the occurrence of hyperkalaemia.

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References

  1. Orme M (1990) Thiazides in the 1990s. Br Med J 300:1668–1669

    Google Scholar 

  2. Swaminathan R (1991) Disorders of metabolism 2. In: Davies DM (ed) Textbook of adverse drug reactions. Oxford University Press, Oxford, pp 412–415

    Google Scholar 

  3. Utiger F, Hoigné R, Maurer P, D'Andrea Jaeger M, Nef S, Zoppi M, Maibach R, Kuenzi UP (1990) Hyperkaliämien unter kaliumsparenden und kaliumverlierenden Diuretika. Schweiz Med Wochenschr 120:1933–1936

    Google Scholar 

  4. Hoigné R, Hottinger S (1988) Monitoring adverse drug reactions in the postmarketing phase. Pharm Acta Helv 1:2–12

    Google Scholar 

  5. Widmer P (1993) Hypokaliémies chez des patients traités avec des diurétiques: le rôle des diurétiques, des compléments potassiques, des glucocorticostéroïdes et des béta-2-sympathomimétiques. Results from the Comprehensive Hospital Drug Monitoring Berne. Doctoral thesis, Faculty of Medicine, University of Berne

  6. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Google Scholar 

  7. Maibach R, Hoigné R, Maurer P, D'Andrea Jaeger M, Egli A, Galeazzi R, Hess T (1990) Risikobeurteilung im Komprehensiven Spital Drug Monitoring Bern/St. Gallen. In Ferber HP (ed) Erfassung und Bewertung unerwünschter Wirkungen von Arzneimitteln. De Gruyter, Berlin, pp. 321–331

    Google Scholar 

  8. Maibach R, Hoigné R, Maurer P, D'Andrea Jaeger M, Capaul R, Egli A, Kuenzi UP, Galeazzi R, Hess T, Neftel K, Mueller U (1991) Anticipating the risk of developing an adverse drug reaction (abstract). J Clin Res Pharmacoepidemiol 5:169–170

    Google Scholar 

  9. Jick H, Miettinen OS, Shapiro S, Lewis GP, Siskind V, Slone D (1970) Comprehensive drug surveillance. J Am Med Assoc 213: 1455–1460

    Google Scholar 

  10. Marble A, Wier GC, Selenkow HA, Rose LI, Dluhy RG, Williams GH, Feely J (1987) Endocrine diseases. In: Speight TM (ed) Avery's drug treatment: principles and practice of clincal pharmacology and therapeutics. Adis Press, Auckland, p 564

    Google Scholar 

  11. Breslow NE, Day NE (1980) Statistical methods in cancer research, Vol 1 Chapter 6, WHO International Agency for Research on Cancer, Lyon, pp 193–246

    Google Scholar 

  12. Hoigné R, Sollberger J, Zoppi M, Mueller U, Hess T, Fritschy D, Stocker F, Maibach R (1984) Die Bedeutung von Alter, Geschlecht, Nierenfunktion, Atopie und Anzahl verabreichter Medikamente für das Auftreten von Nebenwirkungen, untersucht mit Methoden der mulivariaten Statistik. Schweiz Med Wochenschr 114:1854–1857

    Google Scholar 

  13. Lawson DH, O'Connor PC, Jick H (1982) Drug attributed alterations in potassium handling in congestive cardiac failure. Eur J Clin Pharmacol 23:21–25

    Google Scholar 

  14. Lowe J, Gray J, Henry DA, Lawson DH (1979) Adverse reactions to frusemide in hospital inpatients. Br Med J 2:360–362

    Google Scholar 

  15. Spino M, Sellers EM, Kaplan HL, Stapleton C, Macleod SM (1978) Adverse biochemical and clinical consequences of furosemide administration. Can Med Assoc J 118:1513–1518

    Google Scholar 

  16. Andersen B, Snorrason SP, Ragnarsson J, Hardarson T (1985) Hydrochlorothiazide and potassium chloride in comparison with hydrochlorothiazide and amiloride in the treatment of mild hypertension. Acta Med Scand 218:449–454

    Google Scholar 

  17. Morgan T, Myers J (1981) Potassium maintenance: potassium supplements or potassium sparing agents. Acta Med Scand 647 [Suppl]:117–123

    Google Scholar 

  18. Morgan DB, Davidson C (1980) Hypokalaemia and diuretics: an analysis of publications. Br Med J 280:905–908

    Google Scholar 

  19. Van Gilst WH, Tijssen JGP, Van Es GA, Lubsen J (1988) Serum potassium values in relation to the use of diuretics in patients with unstable angina pectoris. Eur Heart J 9:795–799

    Google Scholar 

  20. Burgess CD, Flatt A, Sieber R, Crane J, Beasley R, Purdie G (1989) A comparison of the extent and duration of hypokalaemia following three nebulized beta-2-adrenoceptor agonists. Eur J Clin Pharmacol 36:415–417

    Google Scholar 

  21. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE (1990) Brochodilatator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma. Lancet 336:1396–1399

    Google Scholar 

  22. Neville A, Palmer JBD, Gaddie J, May CS, Palmer KNV, Murchison LE (1977) Metabolic effects of salbutamol; comparison of aerosol and intravenous administration. Br Med J 1:413–414

    Google Scholar 

  23. Lipworth BJ, Tregaskis BF, McDevitt DG (1991) Comparison of hypokalemic, electrocardiographic and haemodynamic responses to inhaled isoprenaline and salbutamol in young and elderly subjects. Eur J Clin Pharmacol 40:255–260

    Google Scholar 

  24. Scheinin M, Koulu M, Laurikainen E, Allonen H (1987) Hypokalaemia and other non-bronchial effects of inhaled fenoterol and salbutamol: a placebo-controlled dose-response study in healthy volunteers. Br J Clin Pharmacol 24:645–653

    Google Scholar 

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Authors and Affiliations

  1. Medical Division, Zieglerspital, Bern, Switzerland

    P. Widmer, R. Capaul & U. Mueller

  2. Medical Division, Kantonsspital, St. Gallen, Switzerland

    R. Galeazzi

  3. Foundation CHDM (Comprehensive Hospital Drug Monitoring), Scientific Secretariat, Zieglerspital, CH-3007, Bern, Switzerland

    R. Maibach, U. P. Künzi & R. Hoigné

Authors
  1. P. Widmer
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  2. R. Capaul
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  3. U. Mueller
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  4. R. Galeazzi
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  5. R. Maibach
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  6. U. P. Künzi
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  7. R. Hoigné
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Widmer, P., Capaul, R., Mueller, U. et al. Diuretic-related hypokalaemia: the role of diuretics, potassium supplements, glucocorticoids and β2-adrenoceptor agonists. Eur J Clin Pharmacol 49, 31–36 (1995). https://doi.org/10.1007/BF00192355

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  • DOI: https://doi.org/10.1007/BF00192355

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