[HSF] Persistant Hyperkalemia

Fri Nov 3 18:16:54 EST 2006

8 hours later K back to 3.6.
So Heparin given and removed - caused increase and then decrease in K +.
Lesson to remember - Heparin can cause alteration in K metabolism at 
least in some patients.
S Creat stable and in normal range after stopping PD for over 12 hours
Prasanna
psimha wrote:
> 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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