Managing Hyperkalaemia In Heart Failure Patients- A Review Of A Case Study At The Komfo Anokye Teaching Hospital, Kumasi, Ghana.

PURPOSE: Angiotensin-converting-enzyme (ACE) inhibitors, Angiotensin-receptor blockers (ARBs), Aldosterone-antagonists and recently Beta-adrenergic blockers are all neurohormonal blocking agents of the renin-angiotensin-aldosterone system. These drugs are used in clinical practice to treat heart failure. A side effect of such therapy is the development of hyperkalaemia.Determination of the incidence of clinical important hyperkalaemia in heart failure patients treated with the above recommended therapy forms the basis of this overview.SETTING: The Medicine Directorate of Komfo Anokye Teaching Hospital, KATH, Kumasi, Ghana, West Africa.KATH is located in Kumasi, the capital of Ashanti Region in Ghana. The geographical location of the 1000-bed teaching hospital, the road network of the country and commercial nature of Kumasi make the hospital accessible to all areas that share boundaries with the Region.The Directorate of Medicine has 220 beds and the patients admitted at the wards aged from 13 years and above. The directorate runs emergency service 24 hours, seven days a week. Referrals from regional hospitals, district hospitals, general practitioners and private clinics are admitted to the medical wards through the emergency unit.A case study involving a 32-year old female who presented with breathlessness, dizziness and easy fatiguability for 2-day duration was admitted at the medical ward of KATH. A full blood count revealed the following; Sodium 145mmol/L (normal range 135-145mmole/l) and Serum Potassium 6.5mmole/l (normal range 3.5-5.4mmole/l). The woman was diagnosed as having heart failure NYHA IV, fast Atrial Fibrillation, with severe rheumatic mitrial regurgitation and mitrial stenosis. The high serum potassium was described as moderate hyperkalaemia.Conclusion: Heart failure patients undergoing treatment must have their full blood count investigated before initiation of therapy and two weeks after to monitor levels of electrolytes. High serum sodium will cause fluid retention and aggravate generalized oedema. Potassium level >5.5mmol/l is likely to cause significant hyperkalaemia. Patients’ medical history must be reviewed and appropriate treatment given.