[HSF] Persistant Hyperkalemia

[psimha]

No clincal evidence of that.
Prasanna
Ed Setser wrote:
> 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 NSAID's , Aminoglycosides withdrawn.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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