[HSF] Persistant Hyperkalemia

Thu Nov 2 11:37:57 EST 2006

problem solved?

-michael

On 11/2/06, psimha <prasannasimha at gmail.com> wrote:
>
>
> 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 NSAID's , Aminoglycosides withdrawn.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 1.5mg/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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