[HSF] Persistant Hyperkalemia

Sat Nov 4 08:26:25 EST 2006

I did not consider it criticism. I just said - aren't we supposed to 
actually be doing it all the time !!
I do agree with that. I don't think that things that I do like 
emaze,indigenous rings etc  etc would be politically correct in some 
parts of the world.

Prasanna

Donald Ross wrote:
> 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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>>>>>
>>>>>
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