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Essay On Hypokalaemia

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This study has shown that approximately 1 in 14 patients admitted to an acute unit had prolonged QT interval . Ventricular arrhythmias are most often associated with QTc values of 500 ms or more (17; 18) and in this group (severe long QTc) the incidence was 1.7%. This is the first study reporting incidence in acute medical admissions. By contrast, prevalence data have shown that prolonged QTc is frequently encountered in an acute stroke unit (5) or CCU (6). These data likely reflect the case mix of the various cohorts, as transmural myocardial ischaemia and intraventricular haemorrhage are factors associated with long-QT but are usually seen within a high-dependency environment. However, long QT (particularly drug-induced long QT) has…show more content…
Use of fluoroquinolones, which have been a cause for concern to their risk for TdP (23), are not promoted as first line (22). Safety issues have also been raised for use of QTc-prolonging antipsychotic medications (2; 24). Such drugs are frequently used in hospital inpatients as delirium can affect a fifth of acute medical admissions (25). NICE guidelines allow for the antipsychotics haloperidol and olanzapine to be used for up to one-week as a therapy for delirium (26). Whether QTc contributes to increased hospital mortality in those with delirium is unknown (27). Prolonged QT interval is known to predict mortality in a variety of other conditions that are frequently encountered in the AMU such as: coronary artery disease (28), heart failure (29) and diabetes mellitus (30; 31). Our data have shown in-hospital mortality of 3.8% in those with normal QTc and 6.0% of those with long QTc. The study was not powered for this outcome but such a difference would be clinically relevant; based upon these data, approximately 1500 patients in each group would need to be studied to detect a difference with 80% power and alpha of 5%. A more prolonged length of stay with long QTc in unadjusted analysis was unexpected but was no longer significant when correcting for patient age and presence of diabetes or electrolyte disturbance.

The strengths of our study include the robust inter-observer reproducibility
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