[HSF] hyperkalemia

[A]

Manoj:
I deliberately waited for a whole day before I responded hoping that other
forum members will tell us their experience. I had a similar situation in
few cases spread over years and I did request the forum for opinion but no
one enthusiastically responded. 
In my opinion Hyperkalemia in spite of adequate dialysis is an enigma that
received little attention because it is rare???..
I would look for other sources for this like an abdominal catastrophe like
gangrenous bowel or a compartment syndrome. Did you use femoral cannulation?
In my cases none of that was the case and yet I had fatal Hyperkalemia.
One thing did you have periods of hypotension? How was the acid base status?
was there unexplained acidosis? That would tell you about an acute abdomen
situation?
The unusual thing in your case is the initial hyperglycemia and the
subsequent hypoglycemia! Did the patient make it? If He did not did you do
an autopsy?

Ahmed

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Manoj Pradhan
Sent: Saturday, March 31, 2007 12:10 AM
To: openheart-l at lists.hsforum.com
Subject: [HSF] hyperkalemia

  Dear forum members,

I would invite your opinions on this rather interesting case I had 3 days
ago. 
A 49 yr old insulin dependent diabetic ( since 15 years ) who had undergone
a CABG with 4 grafts 11 years ago, presented with unstable angina. Angio
revealed 3/4 grafts to be blocked with an LVEF - 30%. He was taken up for a
Redo CABG. During the entire surgery, he had extreemly high sugars (
300-400), very low K ( 2.4-2.8) and a low SVR < 700 with pressures around
120 with very hi cardiac outputs. Assuming him to be septic , he was given
meropenum and vanco with adequate doses of insulin and K supplements( rather
large amounts on pump in view of the persistently low K ). He came off CPB
after the grafts with moderate ionotropes and remained well and stable for
the 1st 24 hours.Thereafter the K started rising ( shift ) with hypoglycemic
episodes, and despite dialysis, a urine output of around 50 ml /hr and
glucose insulin , rapidly climbed to 8.5 followed by a diastolic arrest. I
would welcome the members thoughts on this patient

Manoj Pradhan
Pune

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