BACKGROUND: Hypokalemia is one of the most common electrolyte disorders in hospitalized patients. It is associated with a high mortality rate among patients with cardiovascular disease. Whether hypokalemia confers a similar risk in an unselected hospitalized population is not well established. METHODS: We conducted a prospective cohort study involving all first time admissions (n=11988) to the Acute Medical Department at Odense University Hospital linking potassium level at admission with registry data on patient characteristics, laboratory data, redeemed prescriptions and time of death for the period from August 2009 to August 2011. We estimated hazard ratios for all cause mortality within 0-7 days and 8-30 days after admission, comparing patients with hypokalemia at admission (plasma [K(+)] level < 3.4 mmol/L) with patients with eukalemia at admission ([K(+)] level of 3.4-3.8 mmol/l). RESULTS: Hypokalemia occurred in 16.8% of first time admissions (n=2011). It was associated with an adjusted hazard ratio [HR] of 1.34 (95% confidence interval [CI], 0.98-1.85) for 7-day mortality and 1.56 (CI, 1.18-3.06) for 8-30 day mortality. Among patients with more severe hypokalemia (plasma [K(+)]<2.9 mmol/l) the adjusted HR was 2.17 (CI, 1.34-3.49) for 7-day mortality and 1.90 (CI,1.18-3.06) for 8-30 day mortality. Prognostic factors for both 7-day and 8-30 day mortality among hypokalemic patients were increasing age and Charlson comobidity index whereas there was no prognostic effect of current diuretic or betagonist use. CONCLUSIONS: In a mixed population of hospitalized medical patients, hypokalemia is common and plasma [K(+)]<2.9 mmol/l is associated with increased 7-day and 8-30 day mortality.
American Journal of Medicine, 2015, Vol 128, Issue 1