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January 11, 2012

Potassium Concentration and Repletion in Patients With Acute Myocardial Infarction

Author Affiliations

Author Affiliations: Levine Cardiac Unit, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

JAMA. 2012;307(2):195-196. doi:10.1001/jama.2011.2003

Measuring and repleting serum potassium is an entrenched practice in treating patients with acute myocardial infarction (AMI), is recommended as routine (Class I) in practice guidelines,1,2 and is often codified in hospital admission templates and electronic orders. Achieving a target potassium level requires substantial resources. Frequent blood sampling is necessary to monitor potassium concentration and renal function to determine appropriate dosing according to standardized algorithms. Intravenous potassium replacement is slow, requires strict infusion control in a separate line to prevent potentially lethal overdoses, and when administered peripherally, may be painful and lead to thrombophlebitis. Oral potassium is unpalatable and often insufficient to achieve the target concentration. Moreover, complications of usual care to treat MI may worsen renal function and increase the risk of hyperkalemia, especially in elderly patients.

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