[HSF] Persistant Hyperkalemia (OT)

[Nasser F. Abou'Seada]

Great Surgeons are essentially Great Doctors .... who operate .... 
Surgeons who ae not physicians .... risk being no more than manual workers
..!!!!

NFA

> 
> >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NSAID's , Aminoglycosides withdrawn.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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> 
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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