Management of Hypokalemia in Intensive Care Patients

Hypokalemia is a common electrolyte disorder in critically ill patients and may contribute to substantial morbidity and mortality if inadequately managed. Standardized approaches to hypokalemia management in intensive care units (ICUs) remain limited. This study aimed to develop an expert consensus-based hypokalemia treatment algorithm and to evaluate its implementation with clinical pharmacist involvement in critically ill patients. The study was conducted in the general ICU of a state hospital and consisted of two phases. In the first phase, recommendations derived from current clinical guidelines, relevant literature, and clinical practice were evaluated through a two-round expert consensus process involving specialist physicians and clinical pharmacists with ICU experience. Consensus-based recommendations were used to develop a standardized hypokalemia treatment algorithm. In the second phase, a prospective before-and-after design was used to compare routine ICU care with algorithm-guided hypokalemia management accompanied by clinical pharmacist recommendations. Prespecified outcomes included initiation and timing of potassium replacement therapy, achievement of normokalemia, time to normokalemia, recurrent hypokalemia, treatment-associated hyperkalemia, normokalemia at ICU discharge, and ICU length of stay.

Inclusion Criteria: * Age 18 years and older * Admission to the ICU * ICU stay longer than 24 hours * Documented hypokalemia defined as serum potassium concentration of less than 3.5 mEq/L Exclusion Criteria: * Diabetic ketoacidosis * Active coronary artery disease * Severe renal impairment (GFR less than 15 mL/min/1,73 m²) * Malignant disease * Presence of a cardiac pacemaker * ICU admission following major surgery * Receipt of dialysis therapy * Hypokalemia managed primarily via potassium supplementation added to total parenteral nutrition