All in patients having hyperkalemia were included in the study.

Cases which does not contain relevant information and cases which are referred to higher centers for treatment.

Table.1 and Figure.1 represents the age wise distribution of patient with hyperkalemia in which 32.95% patients were in the age group of 61-70 years. Whereas, 23.86% patients were included in the age group of 71-80 years and 20.83% were included in age group of 81-90 years. In this 15.15%, 4.16%, 2.27% patients were in the age groups of 51-60 years, 41-50 years, 31-40 years respectively. But only 0.75% patients were in the age group >90 years and there is no evidence on incidence of disease in the age <30 years.

Table 2: Distribution according to gender

Table 2 and Figure 2 represent the distribution of patients according to gender, in which 62.12% patients were male and 37.87% patients were females, it represents that the risk of incidence of disease is high in males than that of females.

Table 3: Distribution according to Past medical history

*n=264; Total will not corresponds to 100% because of multiple diseases.

Table 3 and Figure 3 shows the distribution according to past medical history in which 67.42% patients having past medical history of diabetes mellitus, 60.60% with hypertension, 51.13% with Ischemic heart disease and 15.15% with chronic kidney diseases 9.46% having heart failure and 7.57% having thyroid disorders. But only 0.75% patients having the past medical history of anaemia, 18.93% patients having incidence of other disorders except above mentioned.

Table 4: Distribution according to Blood pressure

*n=264; Total will not corresponds to 100% .

Table 4 and Figure 4 show distribution according to blood pressure. 27.6% patients have pre-hypertension in systolic BP on date of admission and 39.01% patients shows normal hypertension diastolic BP on date of discharge, but 40.9% shows normal hypertension in diastolic BP on date of admission and 43.9% are shows normal hypertension in diastolic BP on date of discharge.

Table 5: Distribution according to Etiological factors

*n=264; Total will not corresponds to 100% because of multiple factors.

Table 5 and Figure 5 indicates the distribution of patients according with etiological factors such as drugs, diseases, food habits, adverse drug reactions, drug interactions. These observations represent that 68.5% patients had etiology of diseases, 45.07% with drugs and 75% with adverse drug reactions. Only 17.42% were included in drug interactions and 4.16% is caused by food habits.

Table 6: Distribution according to incidence of hyperkalemia

*n=264; Total will not corresponds to 100% because of multiple causes.

Table 6 and Figure 6 represent the distribution according to incidence of hyperkalemia on the basis of drug induced, disease induced and asymptomatic causes. 35.60% patients had hyperkalemia with the use of ACEI, 35.98% by the use of CCBs and 28.78% by Spironolactone. But in disease induced causes, 67.42% patients were with diabetes mellitus and 62.12% were with hypertension.

Table 7: Distribution according to potassium level

Table 7 and Figure 7 shows the distribution of patients according to potassium levels. In this study 82.95% patients having mild hyperkalemia, 14.01% having moderate hyperkalemia. But only 3.03% of patients show severe hyperkalemia. Study indicates the incidence on severity basis and shows more patients are having mild hyperkalemia and severe hyperkalemia occur in rare cases.

Table 8: Distribution according to Abnormal laboratory values

*n=264; Total will not corresponds to 100% because of multiple abnormal lab values.

Table8 and figure 8 indicates the distribution of patients with abnormal laboratory values, from which 62.5% patients shows decreased hemoglobin level and 32.5% shows abnormality in serum sodium level. Similarly, 16.2%, 3.4%, 2.6% patients shows abnormality in ESR, urea, and serum creatinine respectively.

Table 9: Distribution according to Signs and Symptoms of Hyperkalemia

Table 9 and Figure 9 represent distribution of patients according to signs and symptoms of hyperkalemia. These observations indicates 77.2% patients do not shows any signs and symptoms of hyperkalemia and only 22.7% shows signs and symptoms of hyperkalemia. Study shows that in hyperkalemia patients the signs and symptoms occurs due to many other diseases and usually hyperkalemia symptoms are less likely to occur.

Table 10: Distribution according to Management of hyperkalemia

*n=264; Total will not corresponds to 100% because of multiple drugs.

Table 10 and Figure 10 shows distribution according to management of hyperkalemia by drugs such as Calcium carbonate, Calcium gluconate, Furosemide, Insulin, Calcium polystyrene sulfonate and Salbutamol. 66.66% patients prescribed with Furosemide, 34.09% patients were with Insulin injection, 20.07% patients prescribed with Salbutamol. 4.92% were given with Calcium polystyrene sulfonate, 2.27% with calcium gluconate and only 0.75% patients are prescribed with Calcium carbonates.

Table11: Distribution according to Duration of therapy

Table 11 and Figure 11 shows distribution according to duration of therapy, in which 41.66% patients having duration of therapy about 2 days. 33.33% patients takes about 3 days, 13.63% patients about 4 days, 5.68% takes about 5 days and 5.30% having duration of therapy about one day, but 0.37 % patients takes about 6 days.

Table12: Distribution according to Treatment Approaches

*n=264; Total will not corresponds to 100% because of multiple treatment approaches.

Table 12 and Figure 12 indicate distribution of drugs according to the treatment approaches given to the patients. 3.03% patients are treated with drugs which stabilizing the myocardium and 57.19% patients were treated with drugs which causes shifting of potassium into intracellular space. But largely, 81.43% patients are prescribed with drugs which cause the elimination of potassium from body through urine.

Table13: Distribution according to Rationality

Table13.1: According to Drug Interactions

Table 13.1 and Figure 13.1 indicates distribution according to rationality on the basis of drug interactions in which 97.72% patients having drug interactions and 2.27% patients have no drug interactions.

Table13.2: According to Severity of Drug interactions

*n=264; Total will not corresponds to 100% because of multiple interactions.

Table 13.2 and Figure 13.2 indicates distribution according to severity of drug interactions in which 60.22% patients having mild drug interactions, 99.24% patients having moderate interactions and 33.71% patients having severe drug interactions. 55.68% patients occurs both moderate and severe drug interactions.

Table13.3: According to drug interactions with hyperkalemia

Table 13.3 and Figure 13.3 represent distribution according to hyperkalemia with drug interactions in which 18.93% patients having drug interactions with hyperkalemia and 81.06% patents had no drug interactions with hyperkaemia.

Table13.4: According to Adverse drug reactions

Table 13.4 and Figure 13.4 shows that distribution according to adverse drug reactions, in which 100% patients were having adverse drug reactions.

Table13.5. According to adverse drug reactions with hyperkalemia

Table 13.5 and Figure 13.5 represent distribution according to adverse drug reactions with hyperkalemia. In this study shows 58.33% patients having ADR with hyperkalemia and 41.66% patients shows ADR without hyperkalemia.

Table 13.6: According to Prescription

*n=264 Total will not corresponds to 100%

Table 13.6 and Figure 13.6 indicates the distribution according to rationality of prescription in which the prescription provides right drug for all the patients (100%) but at right dose and dosage regimen only for 56.6% and 95.8% patients respectively. The prescription also provides drugs at right time through right route.

Table 14: Distribution according to commonly used drugs in various disease conditions

*n=264 Total will not corresponds to 100% due to multiple disease conditions.

Table 14and figure 14 represents the distribution according to commonly used drugs in various medical conditions were anemia were treated with 1.09% of calcium carbonate, and 1.51% of calcium gluconate and sodium bicarbonate,34.09% of insulin,4.92% of calcium polystyrene sulfonate and 18.93% of salbutamol but 48.86% were treated with furosemide. In case of diabetes mellitus and hypertension,0.75% were used in calcium carbonate and 1.13% calcium gluconate and 1.51% of sodium carbonate but 42.8% were treated with furosemide. In case of IHD, CKD and hypothyroidism cases were treated with furosemide.

Table 1 and graph 1 indicates the distribution according to age. In the present study, it was observed that 32.95% of patient were in age 61 to 70 years. Allan j Collins et al [1]., conducted a study and the result was in between the age group <65 years had notably higher rate of mild to moderate to severe hyperkalemia. When compared to those age 50-64 years. The another study was conducted by Akshay S Desai et al [16], on the risk of hyperkalemia increased in the age of ≥75 years. In the previous study by Dr. Rathri Roopavathi et al [15]. Correlated of serum potassium level with CKD IV and V were increased risk in age group of 49.7±21.4 years. In a study by Ju-hyun et al [19]., determine the effect of RAS blocked maintenance on renal protective in CKD patient with hyperkalemia who were in 61.8±14.5 years. The epidemiological variations and study population might be reason for this change.

Table 2 and graph 2 indicates the distribution according to the gender. According to the study, 62.15% were males. Ina study by Ju- Hyun et al [19]., 56% were males while in a study done by Dr Rathri Roopavathi et al [15]., in the study included 45 cases of CKD on conservative treatment out of which 24 were men and 21 were women. The author study Akshay et al [16]., the risk of hyperkalemia increased with male gender. But there was 58% were female, Allan J Collins et al [1]., shows they have significantly higher tendency to develop hyperkalemia. This variation may due to the diverse population receiving medical care or not.

Table 3 and graph 3 indicates the distribution according to the past medical history. According to the subjective findings 67.42% of patient had diabetes mellitus and 60.60% of hypertension had the risk of Akshay S Desai et al [16]., mention that patient had the risk of hyperkalemia increased in symptomatic heart failure patients with past medical history of diabetes mellitus , hypertension, CKD. N karunsree et al [18]., found that out of 38 cases 17 had hypertension and 12 patient associated diabetes mellitus. Allan j Collin et al [1]conducted study in which 21% patient had history of diabetes mellitus. The difference may be due to community variations and past histories.

Table 4 and graph 4 represents the distribution according to blood pressure. According to their clinical laboratory findings 27.6% of patients had systolic blood pressure and 40.9% patients had normal diastolic blood pressure at the time of admission. Joy. M. weinberg et al [7]. There was a wide range of systolic blood pressure with mean of 150 mmhg. In nondiabetic patient with CKD disease receiving antihypertensive therapy with risk of hyperkalemia.

Table 5 and graph 5 indicates distribution according to etiological factor in the present study it was observed that 75% of patients had adverse drugs reaction the use of medication. Hiroyuki et al [14]., identify that the use of medications like NSAID, Beta blocker , potassium salt substitute their ADR which are known risk factor for hyperkalemia. While the study conducted by Joy.M. Weinberg et al [7]., concluded that after the initiation of antihypertensive therapy the risk of hyperkalemia greatest with ACE inhibitor to use intermediate with beta blocker and lowest with CCB . The present study was supported by Akshay et al [16]., determined that the cause of hyperkalemia in a broad population of heart patients with increase the incidence with background use of ACE inhibitor, spironolactone, Candesartan.

Table6 and graph6 represents the distribution according to incidence of hyperkalemia. According to this study the majority of patients were found to be disease induced, especially 67.42% of diabetes mellitus. Another study supported to present observation that conducted by Allans j Collins [1] and akshay et al [16]., patients had high risk in background of diabetes mellitus, hypertension and CKD.

Table7 and graph 7 shows that distribution according to potassium level. In this study, 82.95% patients had mild hyperkalemia on the basis of severity. Allan j Collins [1]., conducted study was notably higher range severity of mild to moderate to severe hyperkalemia. This variation occurs may due to difference in the potassium level and the study populations.

Table8 and graph 8 distribution according to abnormal laboratory values. According to clinical laboratory findings 62.5% patients had decreased hemoglobin level and found to be anemic and 39.3% patient had elevated ESR. Dr. Rathriparith et al [15]., mention that 56% patients were in stage V were the mean value of blood urea , serum creatinine, serum potassium are raised above normal in all CKD patients . The variation is due to the epidemiological and diseased conditions.

Table 9 and graph 9 distribution according to signs and symptoms of hyperkalemia. In the present observation study was found that 77.2% patient had hyperkalemia symptoms are less likely to occur. N Karunasree et al [18] conducted study among 30 patients 8 were asymptomatic (26.66%). 22 show varied symptoms related to both their underlying disease and symptoms pertaining to hyperkalemia (73.34%). 22.34% patients had complained nausea, vomiting, headache & dizziness. The variation in the study due to the severity of the hyperkalemia and study population.

Table10 and graph10 distribution according to management. According to this study 66.66% patients were manage by furosemide. Allan j Collins et al [1] 19% of the study population thiazide and loop diuretic therapy were associated with mild and mod- severe hyperkalemia. Joy.M.weinberg et al [7] found that the 75% patients diuretics were used for an average of 75% of follow up visits. After controlling for the most GFR, use of diuretics was associated with a reduction in the probability of hyperkalemia by 59%. Michael H.alderman et al [11] conducted study on the clinical significance of incidence hypokalemia and hyperkalemia in hypertensive patients. And treatment should often included loop and thiazide type diuretic greater than 13% of patients with low to moderate doses of diuretic. However is that the cardioprotective action of diuretic use are unaffected by consequent but treatable alteration in serum potassium.

Table 11 and graph 11 distribution according to duration of therapy in study, 41.66% patient were relieved within the 2 day after the drug therapy, N Karunasree et al [18] showed that all patient showed reduction in the serum potassium level ranging from 0.15 to 4.6 with a mean value of 1.636 reduction of less than 1 milliequivalent in 9 cases, 1.2 milliequelence per liter in 12 cases and 2.3 milliequelence in 3 cases and greater than 4 milliequelence in 1 case.

Table 12 and graph 12 distribution according to treatment approaches another important findings in the study was 81.43% patients had a treatment on elimination of potassium. Allan j collins et al [1] and joy. M. Weinberg et al [7]conducted study show that the elimination of potassium by using diuretics.

Table 13 and graph 13 distributions according to rationality 97.72% of patient with drug interaction out of 81.0% without hyperkalemia. Hiroyuki et al [14] identify that the use of medication like NSAID, beta blocker, potassium salt substitute and their ADR which are the known risk factors for hyperkalemia. N Karunasree [18] conducted study found that are different modalities of treatment which either redistribute potassium from the body. Among the measures that tent to effect the redistribution of potassium in the body. Intravenous insulin are most practiced. IV calcium gluconate brings about rapid change with early onset of action. IV sodium bicarbonate is an effective unless there is coexistence acidosis and beta- agonist in oral cation exchange resin also eliminates potassium from the body. But are useful only in known emergency situations.

The study concluded, hyperkalemia was seen in majority of patents having age group 61 to 70 years and males were prone to hyperkalemia. The causes for the incidence of hyperkalemia was found to be food habits, diseases like diabetes mellitus, hypertension, heart disease, chronic kidney disease, anemia, thyroid disorder and drugs induced like NSAID, spironolactone, ACE inhibitors, calcium channel blockers, heparin and some cases arises from the adverse drug reactions and drug interactions. The severity was seen to be at mild level in which patient had a potassium level 5.12 to 6.0 mEq/l. Diuretics were recommended as the first line drug therapy, according to the study the patients were treated with furosemide by eliminating potassium from the body. It was found that the therapeutic effect occur within two days of hospitalization. To decrease the severity of hyperkalemia , an awareness to the patients must be done about restricted potassium diet, drugs induced and disease induced complications.

The research was conducted as a single site study. So for more accurate results, the study population must be enlarged and multiple site studies have to be performed.