[HSF] Persistant Hyperkalemia

Sat Nov 4 14:48:37 EST 2006

This I believe is a planned challenge under 
highly controlled conditions to determine whether 
there is an adverse response. Anaesthesia does it 
not infrequently.

>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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>>>>>>
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>>>>>
>>>>>
>>>>
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon