[HSF] Persistant Hyperkalemia

Sat Nov 4 07:18:19 EST 2006

I think as men of science -- aren't we doing it all the time ?
Prasanna

Donald Ross wrote:
> 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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