[HSF] Persistant Hyperkalemia

[Ben Bidstrup]

Given the nature of the disease, is there a risk 
that at some stage in the future heparin might be 
needed? Double valve etc. It may be valuable to 
document a true cause and effect rather than a 
putative association. If severe, then a 
recommendation in the future for a direct 
thrombin inhibitor etc may be life saving. (I was 
looking at a case of fatal hyperkalemia on one of 
the medical education websites. This was due to 
an ACE inhibitor being used in heart failure. 
Admittedly heparin should only be used in 
hospital and hopefully carefully monitored.)

>Very appealing and I thought of it but should I risk it ??
>Prasanna
>Ben Bidstrup wrote:
>>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
>>>>>
>>>>>_______________________________________________
>>>>>OpenHeart-L mailing list
>>>>>
>>>>>Send postings to:
>>>>>OpenHeart-L at lists.hsforum.com
>>>>>
>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>
>>>>>All messages transmitted by the OpenHeart-L are subject to the policies
>>>>>and
>>>>>disclaimers posted at:
>>>>>http://www.hsforum.com/listdisclaim
>>>>>-----------------------------------------
>>>>>
>>>>>_______________________________________________
>>>>>OpenHeart-L mailing list
>>>>>
>>>>>Send postings to:
>>>>>OpenHeart-L at lists.hsforum.com
>>>>>
>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>
>>>>>All messages transmitted by the OpenHeart-L are subject to the policies
>>>>>and
>>>>>disclaimers posted at:
>>>>>http://www.hsforum.com/listdisclaim
>>>>>-----------------------------------------
>>>>>
>>>>_______________________________________________
>>>>OpenHeart-L mailing list
>>>>
>>>>Send postings to:
>>>>OpenHeart-L at lists.hsforum.com
>>>>
>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>
>>>>All messages transmitted by the OpenHeart-L 
>>>>are subject to the policies and disclaimers 
>>>>posted at:
>>>>http://www.hsforum.com/listdisclaim
>>>>-----------------------------------------
>>>>
>>>_______________________________________________
>>>OpenHeart-L mailing list
>>>
>>>Send postings to:
>>>OpenHeart-L at lists.hsforum.com
>>>
>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>
>>>All messages transmitted by the OpenHeart-L 
>>>are subject to the policies and disclaimers 
>>>posted at:
>>>http://www.hsforum.com/listdisclaim
>>>-----------------------------------------
>>
>>
>
>_______________________________________________
>OpenHeart-L mailing list
>
>Send postings to:
>OpenHeart-L at lists.hsforum.com
>
>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>http://mmp.cjp.com/mailman/listinfo/openheart-l
>
>All messages transmitted by the OpenHeart-L are 
>subject to the policies and disclaimers posted 
>at:
>http://www.hsforum.com/listdisclaim
>-----------------------------------------


-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon