[HSF] Persistant Hyperkalemia

[Ben Bidstrup]

You could re-expose to heparin and see what happens.

>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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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon