[HSF] Persistant Hyperkalemia

[psimha]

Poked the skunk - gave her Heparin now 5000 U - will let you all know 
tomorrow - doing serial K let us see. Did it since I have the PD 
catheter in place and planning to remove the PD catheter tomorrow. 
Better to have it in and give Heparin once than without !!
Prasanna
Ben Bidstrup wrote:
> 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
>>>>>>
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