[HSF] Persistant Hyperkalemia

Fri Nov 3 00:42:14 EST 2006

I guess this is the US medico-legal system, but why not let this  
patient recover completely from their heart surgery and then test  
them.  Less variables to confound results and if there in fact a  
problem - you dont take the hit for the complication.

"let sleeping dogs lie"

michael

On Nov 2, 2006, at 12:45 PM, 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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