[HSF] Persistant Hyperkalemia

[psimha]

Yes - ruled out compartment syndromes (as a part of hyperkalemia 
examination) (Very relevant question and worth reiterating)
Lactate is normal now.
Found out now that Heparin can cause Aldosterone inhibition so stopped 
that too (in the flushes ) though I do not think that the small doses in 
the flushes should really matter.
Latest K is 5.3 after dialysis (peritoneal) and a GI drip.(Got tired of 
my resident phoning me a value above 6.0)
Prasanna
Michael Firstenberg wrote:
> 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 NSAID's , Aminoglycosides withdrawn.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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