[HSF] Persistant Hyperkalemia

[prasannasimha]

Michael
Patient has stabilized. I was suggested by the CCML group to rule out 
type 4 renal tubular acidosis and while doing a bit of research on that 
I found out a list of Aldosterone antagonists included Heparin. I 
stopped Heparin in the flushes and the  K values came crashing down 
within 3 hours (we were struggling to get it down till then). Was it a 
coincidence - I do not know but it truly decreased in association 
(temporally) with stopping Heparin.
Prasanna
Michael Firstenberg wrote:
> now that you are 2 days into this -
> any better/worse?
> anything manifest itself?
>
> m
>
>
> On 11/2/06, Dr. Roberto Battellini <battr at medizin.uni-leipzig.de> wrote:
>>
>> How high are CPK and CPKMB?
>> Roberto
>>
>> -----Ursprüngliche Nachricht-----
>> Von: openheart-l-bounces at lists.hsforum.com
>> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von
>> prasannasimha
>> Gesendet: Mittwoch, 1. November 2006 16:11
>> An: ccm; OpenHeart-L at lists.hsforum.com
>> Betreff: [HSF] Persistant Hyperkalemia
>>
>> 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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