Comparison of Enteral Versus Intravenous Potassium Supplementation

Phase 4UnknownNCT02015962

Aga Khan University40 enrolled

Overview

Null hypothesis: There is no difference in the efficacy of IVPR and EPR during an episode of hypokalemia. Alternate Hypothesis: There is a mean difference of 15% in Serum Potassium levels between the two groups. Objective: To compare the efficacy EPR and IVPR for treatment of hypokalemia (measured as change in serum potassium levels in milliequivalent/L after potassium replacement)

Hypokalemia is frequently encountered in daily clinical practices of cardiac intensive care unit (CICU). The development of ventricular arrhythmias related to hypokalemia can lead to sudden cardiac death. Thus, potassium replacement therapy is the cornerstone therapy for hypokalemia.Though intravenous potassium replacement (IVPR) in hypokalemia is the preferred route in most intensive care settings, it is associated with known safety risks. Inappropriately administered, IVPR can lead to arrhythmias, cardiac arrest and death 1, 7, 8. Given these risks, IVPR is considered a "high-alert medication" by Institute of Safe Medication practice. Enteral potassium replacement (EPR), with its superior safety profile may be a better alternative to IVPR. A retrospective review showed that the efficacy of EPR was comparable to IVPR in pediatric patients after congenital heart disease. The investigators seek to explore this comparison between EPR and IVPR in a randomized prospective trial

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Acute Hypokalemia

Interventions

Intravenous potassium chlorideDRUG

Oral potassium chlorideDRUG

Eligibility

Sex: ALLMin age: 1 DayMax age: 25 Years

Medical Language ↔ Plain English

Inclusion Criteria: * • All patients undergoing surgical repair/palliation of congenital heart lesion at the Aga Khan University Hospital and admitted to the pediatric cardiac intensive care unit (PCICU) for post-operative management. * Serum potassium levels (\<4.39 meq/l) immediate post operatively * Patients/parents willing to participate in the study * Have a central venous line for IVPR and an arterial line for monitoring and blood draws. * Able to tolerate oral or nasogastric administration of medication for EPR. Exclusion Criteria: * • Patients with acute renal failure (estimated clearance creatinine - eccr \<50) * Patients with paralytic ileus, necrotizing enterocolitis or GI bleeding. * Patients with nausea, vomiting or diarrhea prior to randomization. Patients will not be excluded if these symptoms develop during the trial after the initial recruitment. Based on clinical decision the route of potassium supplementation may be changed if these symptoms. Intention to treat analysis will be used for the primary end point. * Patient with symptomatic hypokalemia (manifested as a rhythm disturbances). * Initial serum K level (post surgery) \< 2.0 mEq

Locations (3)

CICU- Aga Khan University Hospital

Karachi, Sindh, Pakistan

RECRUITING

The Aga Khan University

Karachi, Sindh, Pakistan

RECRUITING

The Aga Khan University

Karachi, Sindh, Pakistan

RECRUITING

Outcomes

Primary Outcomes

The efficacy EPR and IVPR for treatment of hypokalemia (measured as change in serum potassium levels in milliequivalent/liter (mEq/L) after potassium replacement

The intervention arms will be blocked randomized as alternate week for I/V and enteral potassium replacement for trial's operational feasibility. Recruited patients will receive treatment accordingly. In case where a patient develops side effects such as diarrhea or vomiting, even though he will be changed to IV route of potassium supplement, he will be considered enteral supplementation during data analysis till the point when the patient had received enteral replacement. In the IVPR group, potassium will be given according to the hospital protocol through a central line. As per a previously established protocol, repeat serum potassium will be sent 1 hour after replacement in the IVPR group and 2 hours after replacement in the EPR group. Replacement and serum level monitoring will be done till the episode of hypokalemia is resolved.

Time frame: The primary endpoint will be assessed every 1 hour in the IVPR group and every 2 hour in the EPR group after replacement of potassium. The patients will be followed for the duration of CICU stay which will be around 1 week.

Secondary Outcomes

Comparison of adverse effects after EPR and IVPR.

Adverse effects that will be monitored are hyperkalemia (defined as potassium levels \> 5 mEq/L, arrhythmias (defined as any rhythm other than sinus during or within 2 hours of potassium replacement), diarrhea (described as \> 2 loose stools or a single watery stool, during or within 2 hours of potassium replacement , GI bleeds, nausea and vomiting (during or within 2 hours of potassium replacement). These adverse events will be monitored on hourly bases by the CICU nursing staff as per CICU protocol. These adverse events will be documented on the CICU nursing sheet (as per routine) and the data gathered every morning by the principal or co-investigators. The on-call physician will be contacted, as per routine, by the nursing to determine any change in mode/dose of potassium replacement if adverse events occur. The on-call physician will in-turn contact either the principal or one of the co-investigators to further discuss the plan.

Time frame: Adverse events will be monitored every 2 hours after potassium supplementation. The patients will be followed for the duration of CICU stay which will be around 1 week.

Central Contacts

Anwar Ul Haque, MD

CONTACT

922134864791 anwar.haq@aku.edu

Babar S Hasan, MD

CONTACT

922134864364 babar.hasan@aku.edu

Data from ClinicalTrials.gov

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