Elsevier

General Hospital Psychiatry

Volume 31, Issue 3, May–June 2009, Pages 262-265
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
High prevalence of hypokalemia in acute psychiatric inpatients

https://doi.org/10.1016/j.genhosppsych.2009.02.007Get rights and content

Abstract

Background

Hypokalemia is an easily identifiable, clinically important but commonly neglected condition in psychiatric patients. This study intended to examine the prevalence of hypokalemia and its clinical correlates in acute psychiatric inpatients.

Method

This retrospective study was conducted over a 6 month period in 2008. The case notes, computerized records and laboratory results of all patients who were consecutively admitted to the acute psychiatric wards in a University-affiliated regional psychiatric unit were studied.

Result

Three hundred forty-seven patients out of 440 admissions were studied. Hypokalemia, as defined by serum potassium level of less than 3.5 mmol/L, was found in 20.5% of patients with a higher prevalence in psychotic patients (27.7%). The mean potassium level of psychotic patients was lower than that of the overall study population (3.72 vs. 3.81 mmol/L, P<.05). White cell counts among the hypokalemic patients were higher than those without hypokalemia (7.8 vs. 7.1×109/L, P=.02).

Conclusion

Hypokalemia was common among acute psychiatric inpatients. Both agitation and the use of antipsychotics were postulated to contribute to the high prevalence of hypokalemia among acutely ill psychiatric patients.

Introduction

Previous studies found that nearly half of psychiatric patients suffered from various medical diseases [1] but almost one third of the physical conditions were missed, inadequately diagnosed, investigated or managed [2]. Hypokalemia, an easily identifiable and clinically important condition in clinical settings, received little attention from researchers worldwide. Although poor oral intake and drug effects [3] have been implicated as possible etiologies of hypokalemia, detail measurement of nutritional status, psychiatric diagnoses and the choice of psychotropic medications were not closely examined in past studies [4]. Not only is hypokalemia associated with numerous cardiac and neuromuscular complications, but its effect on mental function may also mimic or aggravate psychiatric disturbances [5]. Severe hypokalemia, especially with the combination of arrhythmogenic medications, may lead to potential lethal cardiovascular complications including cardiac arrest and sudden death [6]. As the mechanism of hypokalemia in psychiatric population was not well understood, this study aimed to investigate the prevalence and clinical correlates of hypokalemia in acute psychiatric inpatients.

Section snippets

Method

The case notes and computerized records of all patients who were consecutively admitted to the acute psychiatric wards in a University-affiliated regional psychiatric unit, from February 1 to August 1, 2008, were studied. The following variables of the subjects were taken into account: sociodemographics, duration of hospital stay, principal psychiatric diagnoses by International Statistical Classification of Diseases, 10th Revision, comorbid physical conditions as well as blood results. The

Results

A total of 440 admissions were recorded in the study period. Two hundred thirty-four patients (53.2%) were admitted through the casualty department, 116 (26.4%) via outpatient clinic, and 90 (20.5%) were transferred from nonpsychiatric wards. Among them, 86 patients (19.5%) had no previous psychiatric contact. Ninety-three entries were voided, as 87 subjects lacked relevant laboratory investigations and six subjects suffered from major medical diseases including prominent renal failure, Cushing

Discussion

Previous study found that hypokalemia was common in medical inpatient settings [7]. About 20% of stroke and 10% of myocardial infarction patients suffered from hypokalemia [8]. The considerable prevalence of hypokalemia was understandable given the fact that these medical conditions were commonly associated with various comorbidities and the use of diuretics and haematinics that could lead to excessive potassium loss [7]. Surprisingly, the prevalence of hypokalemia (20%) in our acute

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