1. Potassium repletion in the CCU: IV vs PO

2. Background Potassium repletion is commonly performed in the wards and ICU/CCU Normal potassium (per Quest) is 3.5-5.1 meq/l Studies have estimated more than 20% of inpatients have hypoK <3.5 (Cohn 2000) Repletion done to prevent effects of hypoK

3. Hypokalemia Symptoms typically occur when levels <3 meq/L – Unless falls rapidly or predisposed to arrhythmia Muscle dysfunction can occur – Weakness, cramps, rhabdo, respiratory failure Arrhythmia – Premature atrial and ventricular beats, sinus bradycardia, paroxysmal atrial or junctional tachycardia, atrioventricular block, ventricular tachycardia or fibrillation, etc…

4. HypoK in CCU Potassium goals in CCU (~4meq/l), higher than in regular medicine ward patients – CHF Risks of dysrhythmias, syncope, cardiac arrest, or death are greater in patients with CHF (Leier 1994) HypoK also has been linked to sudden cardiac death in CHF patients (Nolan 1998) – Arrhythmias HypoK patients who have cardiac ischemia, heart failure, or left ventricular hypertrophy have increased risk of arrhythmias (Cohn 2000)

5. Prior cost projects 2015 cost projects looked at IV and PO use in general medicine service – Noted that 45.8% of patients receiving potassium on single day (n=24) had IV repletion despite having PO diet – $41.62 (IV) vs $12.95 (PO) daily, equates to $10,464 cost savings yearly if used PO instead of IV Cost of PO vs IV potassium at UCI – Potassium chloride 10meq tab: 35 cents – Potassium chloride 20meq oral solution: 56 cents – Potassium chloride IV 20meq vial: $2.25 – Potassium phosphate IV 4.4meq vial: $16.92

6. Current Study Question In CCU/Cardiology service patients, how many patients appropriately received oral potassium if able to tolerate a oral diet?

7. Methods Currently project looks at potassium repletion in CCU/Cardiology service patients – Population where potassium repletion occurs frequently to meet goals of K= ~ 4 – Many CHF, ACS, cardiac ischemia, arrhythmia patients Investigated potassium repletion – Collected data on first 10 patients to receive AM potassium repletion during block 11

8. Results PotassiumNPO?OralIVAppropriate PO vs IV? 3.5N60Yes 3.9N20Yes 3.6N40No 3.8Y40Yes 3.7N20Yes 3.4N60No 3.7Y40Yes 3.9N20Yes 3.6N40Yes 3.3N40No

9. Results N= 10 7/10 cases (70%), proper PO vs IV K repletion – 3/10 cases (30%) got IV when patient could tolerate PO Cost difference – 120 meq IV potentially could have been given PO IV cost= $13.5, PO cost= $4.20

10. Discussion Improved percentage of patients getting appropriate PO vs IV repletion – 54.2% previously, 70% now Reasons for continued IV repletion despite PO diet? – 2/3 cases occurred when potassium levels were flagged as red (3.4 & 3.3), thus prompting IV repletion UCI Pharmacy states no sig difference in rate of uptake between PO tabs and IV – Unclear?? Perhaps given cardiac conditions?

11. Limitations Small sample size Looked only at 1 service – Same team (attending, fellow, resident, interns) Did not look at how much was repleted and if would be projected to meet goal of 4 or higher/lower