[HSF] Persistant Hyperkalemia

Donald Ross donross at bigpond.com
Sat Nov 4 08:16:21 EST 2006 

Prasanna, welcome to the union of unauthorised human experimentation.
Don
On 03/11/2006, at 11:46 PM, prasannasimha wrote:

> 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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