Kidney Week

Abstract: TH-PO325

Electronic Alerts (E-alerts) for Electrolyte Disturbances

Session Information

• Sodium, Potassium, and Volume Disorders: Clinical
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid, Electrolytes, and Acid-Base Disorders

• 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Murashima, Miho, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Miho Murashima, MD, PhD

• Ono, Minamo, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Minamo Ono

• Mizuno, Masashi, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Masashi Mizuno, MD, PhD

• Suzuki, Kodai, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Kodai Suzuki, MD

• Miyaguchi, Yuki, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Yuki Miyaguchi

• Kasugai, Takahisa, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Takahisa Kasugai, MD

• Tomonari, Tatsuya, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Tatsuya Tomonari

• Hamano, Takayuki, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Takayuki Hamano, MD, PhD

Background

The impacts of e-alerts for acute kidney injury on outcomes have been debated. We implemented e-alerts for electrolyte disturbances, which are common but often overlooked or mismanaged. The study aims to examine the changes introduced by e-alerts for electrolyte disturbances.

Methods

This is a retrospective observational study at Nagoya City University Hospital. E-alerts for electrolyte disturbances were implemented in May 2021. The criteria for e-alerts were serum sodium <125 or >160 mEq/L, potassium <2.5 or >6.0 mEq/L, corrected calcium <7.5 or 11.5 mg/dL, and magnesium <1.0 or >4.0 mg/dL. The following outcomes were compared 1 year before and after the initiation of the e-alerts: nephrology referral for electrolyte disturbances; for those with hyponatremia, the proportion of patients with measurement of urinary sodium concentration and osmolarity, length of stay, the number of falls during hospitalization, and overcorrection of hyponatremia. Descriptive statistics were used except for the number of referrals and falls, which were compared by Poisson and negative binomial regression, respectively.

Results

The number of electrolyte measurements was 185,305 and 19,238 one year before and after the initiation of e-alerts. The nephrology referrals for electrolyte disturbance increased from 5.6 to 9.7 per month (incidence rate ratio [IRR]: 1.75 (1.13-2.76)). Among those with hyponatremia, the proportion of patients with urinary sodium concentration and osmolarity measured increased from 34.9% to 47.2%. The length of stay decreased from 27 (15-47) to 20 (12-36) days for those with hyponatremia, whereas the length of stay did not change for those without hyponatremia. The number of falls was lower after initiating e-alerts (IRR: 0.82 (0.44-1.50)), though not statistically significant. The number of overcorrections of hyponatremia decreased from 22.1% to 15.3%. Eight out of 27 patients referred for hyponatremia within 1 year after the initiation of e-alerts were diagnosed with syndrome of inappropriate antidiuretic hormone secretion and tolvaptan improved hyponatremia in 4 patients.

Conclusion

E-alerts for electrolyte disturbances increased nephrology referral, urinary sodium and osmolarity measurements, decreased length of stay, falls, and the overcorrection of hyponatremia.