[HSF] Persistant Hyperkalemia

Thu Nov 2 21:37:40 EST 2006

Preop K was normal. Any way the K levels have normalized now and we have 
decreased and finally stopped PD frequency.
Prasanna
Nasser F. Abou'Seada wrote:
> 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 NSAID's , Aminoglycosides withdrawn.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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