The Frequency and Association of Dyskalemias With Types of Arrhythmias and Their Predictors in Emergency Cardiac Care Patients

BACKGROUND: Serum potassium is a critical determinant of myocardial excitability and conduction. Dyskalemias can trigger life-threatening arrhythmias, including ventricular tachycardia (VT) and ventricular fibrillation (VF). Even mild derangements in potassium levels can destabilize cardiac electrophysiology and precipitate serious arrhythmias. In emergency cardiac care, dyskalemias are frequently encountered but often underrecognized contributors to electrical instability, morbidity, and mortality. OBJECTIVE: To determine the frequency of serum potassium derangements and assess their association with the type of arrhythmias in patients presenting to emergency cardiac care. Thirdly, to determine the co-morbidities that can be predictors of arrhythmias. METHODS: This cross-sectional analytical study was conducted in the Department of Emergency Cardiac Care at Shaikh Zayed Hospital, Lahore, Pakistan, from July 2024 till December 2024, including 185 patients presenting with acute cardiac complaints. Serum potassium levels were measured at admission and categorized as hypokalemia (<3.5 mmol/L), normokalemia (3.5-5.0 mmol/L), or hyperkalemia (>5.0 mmol/L). Electrocardiograms and continuous monitoring were used to document arrhythmic events. RESULTS: The mean age of patients was 58.6 ± 12.4 years; 60.5% were male. Dyskalemias were present in 50.3% of patients. Hypokalemia was observed in 31.4%, hyperkalemia in 18.9%, and normokalemia in 49.7%. Arrhythmias occurred in 42.7% of cases, with ventricular arrhythmias significantly associated with hypokalemia (36.2% vs. 10.9%, p<0.001), and bradyarrhythmias/conduction blocks linked to hyperkalemia (25.7%, p=0.002). Logistic regression showed hypokalemia independently increased the odds of arrhythmias (OR=4.89; 95% CI: 2.45-9.75; p<0.001). Chronic kidney disease (CKD) was also an independent predictor of overall arrhythmic occurrence (OR=2.11; 95% CI: 1.04-4.27; p=0.03), likely reflecting its dual contribution to both hyperkalemia and electrical instability. CONCLUSION: Potassium derangements are common in emergency cardiac patients and significantly increase the risk of arrhythmias. Hypokalemia predisposes to ventricular arrhythmias, while hyperkalemia more often results in bradyarrhythmias and conduction blocks. Chronic kidney disease is an independent predictor of arrhythmias.