[HSF] Persistant Hyperkalemia

[Michael Firstenberg]

an obvious question - even though I know you are a very good doctor (and not
just a great surgeon) - no compartment syndrome anywhere?  (arm from a-line,
legs).  The lactate is also concerning?  I have seen this a few times, just
kinda goes away and never really sure why.

michael


On 11/1/06, prasannasimha <prasannasimha at gmail.com> wrote:
>
> No not on Metformin (Not a diabetic) or any Aldosterone inhibitors,
> NSAID's , Aminoglycosides withdrawn. No known preop problem to cause
> hyperkalemia.
>
> Prasanna
>
> Michael Firstenberg wrote:
> > any pre-op medical problems?
> > Metformin pre-op?
> >
> >
> > michael
> >
> >
> > On 11/1/06, prasannasimha <prasannasimha at gmail.com> wrote:
> >>
> >> Double valve replacement with Tricuspid annuloplasty done 2 days back.
> >> Uneventful post op and extubated on 5 mics of dobutamine and dopamine.
> >> Started getting hyperkalemia since today 3 AM. No clinical or
> >> biochemical evidence of low output/hemolysis. Urine clear.Echo normal -
> >> no evidence of paravalvar leak . Lactate 2.7 mmol. Creat 1.5 mg/dL and
> >> BUN 43 mg/dL
> >> Initially manged hyperkalemia with Lasix , Calcium , glucose Insulin
> >> Alkalinizaation K binding resin etc but K went upto 6.8 so started
> >> PDtoday mrning. K+ dropped to 5.1 but now despite good extraction on PD
> >> , good urine etc last K+ just done now is 6.0. Cannot identify the
> cause
> >> of such persistant hyperkalemia. I have removed all nephrotoxic drugs.
> >> No additional K + sources and I have specifically asked K free diet.
> >> Any ideas/suggestions.
> >> Prasanna
> >>
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