NATIONAL JOURNAL OF MEDICAL RESEARCH print ISSN: 2249 4995│eISSN: 2277 8810

ORIGINAL ARTICLE

STUDY OF SERUM SODIUM AND POTASSIUM

DISTURBANCES IN PATIENTS OF ACUTE MYOCARDIAL
INFARCTION
Amita A Gandhi1, Pankaj J Akholkar2, Vahid S Bharmal3

Author’s Affiliations: 1Assistant Professor, 2Associate Professor, Medicine, GMERS Medical College, Sola, Ah-
medabad; 3Associate Professor, Medicine, M P Shah medical college, Jamnagar, Gujarat
Correspondence: Dr. Amita A. Gandhi, Email: [email protected]

ABSTRACT
Background: The incidence of myocardial infarction is increasing specially in developing countries. Dif-
ferent electrolytes such as potassium and sodium play an important role in the cell metabolism, electrical
conduction and membrane excitability. Abnormalities of these electrolytes due to different causes can
lead to a significant cardiac life threatening events.
Objective :To ascertain the electrolytes status in patients of acute ST elevation myocardial infarction
(STEMI) at the time of hospitalization and to study the relationship between hyponatremia and hypo-
kalemia with ventricular arrhythmia and survival status of the patient on day seven of the admission.
Methods: Fifty patients of acute myocardial infarction were interrogated for history of presenting illness,
examined for vitals, systemic examination and investigated by collection of blood sample and ECG.
Conclusion: There was increased mortality in patients with hyponatremia, but p value was not statisti-
cally significant (p value 0.15). There was definite correlation between hypokalemia and ventricular ar-
rhythmias and there was increased tendency towards developing ventricular arrhythmias in patients with
hypokalemia.( p value 0.009).

Key words: Acute myocardial infarction, Electrolytes, Serum Sodium, Serum potassium

INTRODUCTION METHODOLOGY
Cardiovascular disease is one of the leading causes This was an observational prospective study. In-
of morbidity and mortality across the world. World formed written consent was taken from all sub-
Health Organization (WHO) has declared cardio- jects.After obtaining detailed medical history and
vascular disease as a modern epidemic.1 Acute clinical examination of the patient blood sample
Myocardial Infarction is one of the manifestations were taken for laboratory investigations including
of coronary heart disease leading to morbidity and Serum Electrolytes, Blood Sugar, Renal function
mortality. Arrhythmias and hemodynamic abnor- test, Liver Function Test, and treatment of the
malities in left ventricular dysfunction are the ma- patient was initiated with standard anti ischemic
jor causes of mortality along with acute myocardial therapy and serial ECG of the patient were done.
infarction. The arrhythmias predisposing factors Serum electrolytes done were serum sodium, se-
are: autonomic nervous system dysfunction, elec- rum potassium.
trolyte disorders, left ventricular dysfunction, myo-
At the beginning of admission and in a resting po-
cardial ischemia and medications.2 Different elec-
sition, the blood sample was taken from patients’
trolytes such as potassium and sodium play an im-
left cubital vein. The sucking pressure in venipunc-
portant role in the cell metabolism, electrical con-
ture was tried to be very slow. The blood samples
duction and membrane excitability. Abnormalities
were slowly transferred to the test tube and then to
of these electrolytes due to different causes can
the laboratory without any shake.
lead to a significant cardiac life threatening events.3

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Inclusion Criteria RESULTS

Patients of STEMI (ST elevation myocardial in- In our study population, 64 % (n=32) were male
farction) as diagnosed clinically, by ECG and by and 36% (n=18) were female. Out of these 22%
biomarkers. All patients of AMI (acute myocardial (n=11) patients died during first seven days.
infarction) were medicated with angiotensin con- Amongst the patients died 14% (n=7) were male
verting enzyme inhibitors or angiotensin receptor while 8% (n=4) were female.
blockers over and above the standard throm-
Majority of study subjects (76%) had normal se-
bolytic, anti ischemic and anti platelet therapy.
rum sodium of 136-145 mmol/l. Study subjects
Exclusion Criteria: Anaemia, significant hepatic, with serum sodium level < 136 mmol/L were (14
renal and pulmonary disease, diabetes mellitus, %) & serum sodium level >145 were 10 % (n=5).
infection, hypo and hyperthyroidism.
Table 2 shows that mortality in patients with se-
All the patients of the STEMI were grouped ac- rum sodium <136 mmol/l was 42.8 %( 3 out of 7),
cording to while in patients with normal serum sodium level
was 18 %( 7 out of 38) and in patients with serum
Serum sodium (mmol/l) <136mmol/l, 136-
sodium level> 145 mmol/l was 20 %( 1 out of 5).
145mmol/l, >145mmol/l
Thus patients with hyponatremia had higher rate
Serum potassium (mmol/l) <3.5mmol/l, 3.5-
of mortality, but p value is not significant (p value
4.5mmol/l, >4.5mmol/l
0.15).
Observed outcome was survival status on the sev-
Table 3 shows majority of patients 80 %( n=40)
enth day of admission and development of ven-
had normal serum potassium level, while 12 %(
tricular Arrhythmias. The observed clinical out-
n=6) had serum potassium level less than 3.5
come was analysed by Chi square test .P value of
mmol/l and 8 %( n=4) had more than 5.5 mmol/l.
less than 0.05 was taken as statistically significant.

Table 1- Distribution of study subjects according to serum sodium level.

Serum Sodium Level Total Patient Male Female
(mmol/L) (%) (n=50) (%) (n=32) (%) (n=18)
< 136 7(14) 5(15.6) 2(11.1)
136-145 38(76) 25(78.1) 13(72.2)
> 145 5(10) 2(6.3) 3(16.7)

Table 2 -Occurrence of Mortality as per serum sodium level

Serum Sodium Level Total Patients Mortality Male Female
(mmol/L) (%) (n=50) (%) (n=11) (%) (n=7) (%) (n=4)
< 136 7(14%) 3(27.3%) 2(28.6%) 1(25%)
136-145 38(76%) 7(63.6%) 5(71.4%) 2(50%)
> 145 5(10%0 1(9.1%) 0(0%) 1(25%)

Table 3- Distribution of Study subjects according to serum potassium level

Serum Potassium Level Total Patients Male Female
(mmol/L) (%) (n=50) (%) (n=32) (%) (n=18)
< 3.5 6(12) 4(12.5) 2(11.1)
3.5-5.5 40(80) 25(78.1) 15(83.3)
> 5.5 4(8) 3(9.4) 1(5.6)

Table 4-Ventricular Arrhythmias in study subjects according to serum potassium level

Serum Potassium Total Patients Ventricular arrhythmias Male Female
level(mmol/L) (%) (n=50) (%) (n=12) (%) (n=8) (%) (n=4)
< 3.5 6(12) 4(33.3) 3(37.5) 1(25)
3.5-5.5 40(80) 7(58.3) 4(50) 3(75)
> 5.5 4(8) 1(8.3) 1(12.5) 0(0)

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Table 4 shows that 66.77 %( 4 out of 6) patients Out of 7(14%) patients who had hyponatremia 4
with serum potassium level less than 3.5mmol/L (8%) patients developed congestive heart failure
had developed ventricular arrhythmias and these during hospital stay. Out of 38 patients with nor-
four patients had serum potassium level mal serum sodium level 5(10%) had developed
≤3mmol/L. 25% (1 out of 4 ) patients with serum congestive heart failure. So it is evident from our
potassium > 5.5mmol/L had developed ventricu- study that hyponatremia is associated Heart failure
lar arrhythmias. 17.5% (7 out of 40) patients with and mortality was also on higher side.
serum potassium level 3.5-5.5mmol/L had devel-
Mean sodium level of the patients survived was
oped ventricular arrhythmias. Thus patients with
139.35+5.68 and in patients who died was
hypokalemia are found to be associated with in-
131.54+15.16. So, it was found that mortality was
creased incidence of ventricular Arrhythmias and p
higher in patients with hyponatremia, though dif-
value is significant (p 0.009).
ference was not statistically significant perhaps due
Out of 31 subjects with serum potassium level ≤ to small sample size.
4.5mmol/L, nine subjects had developed ventricu-
Serum Potassium Level, Survival Status &
lar arrhythmias and four subjects with serum po-
Complications: Normal potassium level consid-
tassium level ≤3mmol/L had developed ventricu-
ered in our study was 3.5-5.5 mmol/L. Hypo-
lar arrhythmias. Thus there was increased trend
kalemia is defined as serum potassium level <3.5
towards developing ventricular arrhythmias as se-
mmol/L. In STEMI hypokalemia has been found
rum potassium level decreases from 4.5mmol/L
to be associated with increased risk of ventricular
and once it decreases ≤3mmol/L incidence of ar-
tachycardia and ventricular fibrillation.12The
rhythmias reached 100%.
physiological mechanisms that may account for the
relationship of hypokalemia to cardiac arrhythmias
are not fully explained; however, it has been sug-
DISCUSSION
gested that low extracellular potassium could in-
Patients of STEMI were examined within 24 hrs crease automaticity (increased slope of diastolic
to collect information about their electrolytes as depolarization) resulting in a decreased conduction
early as possible after the episode so that mortality velocity.
can be viewed in light of prevailing electrolyte
In our study mean serum potassium level was
status.
4.214±0.79.In study by Esha mati et al8 (n=50)
Serum Sodium Level, Survival Status & Com- mean serum potassium level was 3.66 ± 0.56. In
plications: Hyponatremia is defined as serum so- study by Vinod Wali et al9(n=36) mean serum po-
dium level < 136 mmol/l. In acute myocardial in- tassium level was 4.18±0.63.
farction, nonosmotic release of vasopressin may
In our study in patients with myocardial infarction
occur due to the acute development of left ven-
12%(n=6) had hypokalemia..In study conducted
tricular dysfunction; in response to pain, nausea
by Taysir S Garadah,13 30%(n=84) out of 274
and major stress, the most common mechanisms
patients had hypokalemia .In study by Azin Ali-
of hyponatremia in adults; or in response to the
zadehasl14 about 12.2% (n=61) of the overall 500
administration of analgesics and diuretics. 4,5 In this
patients studied, had significant hypokalemia.In
setting, vasopressin level increases concomitantly
study by Richard J. Solomon12, 14%(n=21) of the
with the activation of other neurohormones such
overall 151 patients studied had hypokalemia.
as renin and nor epinephrine.6 Moreover, the renal
effect of vasopressin is enhanced in heart failure, Incidence of ventricular arrhythmias: Serum
as the vasopressin-regulated water in the collecting potassium < 3.5 meql/dl,four (66.67%) patients
duct is up regulated.7 had Ventricular Arrhythmias (p value 0.009)
While it was observed in 4(10%) patients out of
Mean serum sodium level in study by Esha mati8
40 normokalemic patients. Out of 40 patients
et al (n=50) was135±5.17 while in Vinod9 wali et al
with normal serum potassium level, mortality was
(n=36) it was 129.47±4.87.Mean serum sodium
found in nine (22.5%) patients. Amongst four
level in our study was 137.64±9.08.
patients who had hyperkalemia two patients de-
Hyponatremia was found in 14% (n=7) patients in veloped ventricular tachycardia.
our study, while in study by Alexander Goldberg10
In a study by Jan Erik Nordrehaug15, MD, ven-
12.5% (n=131), and in Singla et al11 23.1% (n=341)
tricular fibrillation occurred in 17.2% of 122 hy-
had hyponatremia.
pokalemic patients and in 7.5% of 952 normo-
kalemic patients (p <0.01).

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In study by Richard J. Solomon12 , 24.5% (n=37) correlation found between hypernatremia and
patients experienced either ventricular tachycardia mortality. There was no correlation found between
or ventricular fibrillation.67% of patients with a increased potassium level and ventricular arrhyth-
serum potassium of less than 3.1 mmol/L had mias in our study.
these serious ventricular arrhythmias compared to
40% of patients with a serum potassium between
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