[HSF] Persistant Hyperkalemia

Donald Ross donross at bigpond.com
Sat Nov 4 13:38:07 EST 2006 

My comment was far from critical, rather congratulations and welcome  
to the brotherhood  responsible for most  advances in surgery as  
opposed to the politically correct evangelists.
  (Imagine how you would have fared if you had submitted your  
experiment to an ethics committee?)
Don
On 04/11/2006, at 12:48 PM, prasannasimha wrote:

> 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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