Study of cardiac biomarkers in severe hypokalemia

Pasham Rajesh Kiran, Nayan Kumar Patel, Gouri Oram, Butungeshwar Pradhan


Background: Potassium haemostasis is critical in cellular functioning, cardiac rhythm and neuromuscular wellbeing. Hypokalemia is associated with adverse cardiac, neuromuscular, gastrointestinal outcomes.
Cardiovascular mortality owing to arrhythmia is more common with altered potassium levels. Correlating hypokalemia with cardiac biomarkers is still not conclusively documented although many AMI cases report significant hypokalemia. So present study tries to make a point on impact of severe hypokalemia on cardiac biomarkers.
AIM & Objectives: To determine the effect of severe hypokalemia on levels of cardiac biomarkers.
Materials and Methods: A longitudinal observational study included in patients with clinically suspected and confirmed biochemically as hypokalemia. 102 patients enrolled after consent and ethical clearance. Severe hypokalemia patients were grouped into 2 with serum K+ level <2 meq/l and in between 2-2.5 meq/l.  Results were interpreted in terms of demographic variables and in terms of Serum cardiac biomarkers-Trop I, Total Creatinine Phosphokinase and CPK-MB. ECG changes of ACS (ST changes) were analysed statistically in both groups.
Result and conclusion: 81 patients had serum Potassium level < 2 meq/l and 21 patients had between 2-2.5 meq/l (Mean 1.781 0.35). There was significant difference of CPK-MB and Trop-I values between these two groups having 2 value 6.11 and 8.35 respectively with p value <0.05. Total CPK level was not
significantly different in both groups. In terms of ECG changes suggestive of ACS, sensitivity of 100% was observed in patients with serum K+<2 meq/l, whereas specificity of 32% was observed in the other group. Results document severe hypokalemia induced acute myocardial injury with evidence of significant
elevation of cardiac Biomarkers with ECG changes suggestive of ACS/Acute MI mostly seen in the group with serum potassium value <2 meq/l.

Keywords: Hypokalemia, ECG.

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