Routine
but deadly drug: potassium chloride has a
Jekyll and Hyde personality
March 23, 1997
By CAROL BENFELL Press Democrat staff writer
SANTA ROSA .
Used in trace amounts the equivalent of a few grains of sand in a bucket
of water it is essential for the electrical conduction that makes muscles
and nerves work. It is routinely used whenever a patient is dehydrated
or debilitated or unable to take nourishment by mouth.
"It's used on an incredibly frequent basis," said Loriann DeMartini,
the state Department of Health Services official who is investigating the
recent deaths of two patients, Irene Fox and Beverly Coffman, in Santa
Rosa hospitals.
"Anyone who receives an IV for an extended
period of time will get potassium, because it's such an essential electrolyte."
But potassium chloride is deadly in its concentrated form, short- circuiting
the same muscle and nerve functions it protects in dilute amounts.
The concentrate version is what Dr. Jack Kevorkian
has used in his assisted suicides because of the speed and effectiveness
with which it works, said Det. Sgt. Steve Rapp, who heads the Coroner's
Office for the Sonoma County Sheriff's Department.
"The heart is a muscle with electrical conduction. Potassium chloride
neutralizes the heart,'' Rapp said. ""It causes a sudden cardiac
arrest."
Potassium chloride also is the third and final
drug administered in prison executions by lethal injections, now legal
in California. The compound stops the heart and death follows within one
to two minutes, prison officials said.
It is not unusual for a hospital patient to have a bad reaction to a drug,
although deaths are rare.
Between three and six patients out of every 100 hospitalized will have
what is called ""an adverse drug event"--a bad reaction
ranging from a mild rash to vomiting to lifelong disability or death, according
to a four-year study reported in January in the Journal of the American
Medical Association.
At least half of those incidents could have been
prevented, the landmark study of two Utah hospitals concluded.
AMA Journal editor Jerry Avorn summarized the study by writing, "It
is vital to remember that adverse drug events in hospitals are common,
costly and preventable in many cases."
His commentary described a mix-up between Lasix and potassium chloride
the cause of Beverly Coffman's death as a "hair-raising example"
of the problem.
In the study, researcher David C. Classen and
his colleagues also concluded that medical error--prescription or administration
of the wrong drug or the wrong dose--will cause an adverse drug event in
three out of every 10,000 hospital patients.
That figure translates to three to four erroneous drug prescriptions or
administrations a year to patients at Memorial Hospital, which sees 12,000
patients annually and one or two a year at Community, which sees about
5,000 patients annually.
Memorial spokesman Larry Maniscalco, however, said Memorial's figures showed
about one adverse drug event per 100 admissions, significantly lower than
the Utah study. That count did not reflect whether or not the reaction
was caused by medical error.
"Of course, I don't know that everything is reported that could be
reported," Maniscalco said.
Figures for Community Hospital could not be obtained by publication time.
Copyright 1997, The Press Democrat. Reprinted with permission.
See also: Fatal errors: hospitals learn lessons
the hard way
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