[HSF] Persistant Hyperkalemia

[Ed Setser]

peri-op adrenal insufficiency?
----- Original Message ----- 
From: "psimha" <prasannasimha at gmail.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Wednesday, November 01, 2006 12:19 PM
Subject: Re: [HSF] Persistant Hyperkalemia


> 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 NSAID's , Aminoglycosides withdrawn.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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