[HSF] Persistant Hyperkalemia

[Nasser F. Abou'Seada]

levels ? 
preop K+ levels ? if available ?? 

NFA
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of psimha
> Sent: Wednesday, November 01, 2006 7:59 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Persistant Hyperkalemia
> 
> 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 NSAID's , Aminoglycosides withdrawn.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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