[HSF] Persistant Hyperkalemia

[Nasser F. Abou'Seada]

what was the preop diagnosis ? .. preop condition ? .. 
what is her urine K+ ? .. S.Mg++ ?? 

NFA

> From: 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 NSAID's , Aminoglycosides withdrawn.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