[HSF] Persistant Hyperkalemia

Fri Nov 3 08:09:13 EST 2006

Gave 5000 units of Heparin and no external K source and ongoing Lasix 
infusion (steady state of whatever was going on) K rose from 3.4 to 4.8 
mmol/dL in 3 hours (was around 3.5 from the last six hours prior to the 
Heparin). So Heparin does seem to have a K retaining effect.!! I asked 
them to stop heparin again. If K falls now it would demonstrate a 
probable drug withdrawal effect. (Exposure effect removal - decrease in 
effect).
Prasanna
psimha wrote:
> 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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