[HSF] Hyperkalemia

[Shahid Mahmud Malik]

Ahmed,
Like I said,I am not sure why the hyerkalemia did not respond despite 
adequate dialysis and urine output around 50mls per hour.Dialysis usually 
bails us out in these situations,unless there was some sort of filter 
problem providing inadequate filteration or such related technical 
problems?We should also keep in mind the rare serum K rise secondary to the 
use of Heparin in flushes and for dialysis.
Shahid Malik
----- Original Message ----- 
From: "A" <alsadd at ksu.edu.sa>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Monday, April 02, 2007 3:12 AM
Subject: RE: [HSF] Hyperkalemia


> Shahid Malik:
>
> What do you think the cause of Hyperkalemia in spite of the adequate
> dialysis?  Your input please
>
> Ahmed
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Shahid Mahmud
> Malik
> Sent: Sunday, April 01, 2007 3:57 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: [HSF] Hyperkalemia
>
>
>
> Manoj,
> The insulin dependent diabetics in my experience always require a lot of
> extra management issues.Exactly why the sequence of events happened in 
> your
> case, I cannot comment with any certaininty.However following are my 
> general
> obsevations,
> 1) They over years of regular Insulin use,have a very high total body
> potassium.
> 2) Most IDDM patients usuallly have an abnormal serum creatinine and low
> GFRs.The GFRs may not be calculated in every patient and giving them drugs
> like Vancomycin may further knock off their excretory reserve.
> 3) Many IDDM patients have compromized LV functions (low EFs) and may not
> have adequate cardiac output in the immediate post op period which may
> further complicate renal output.
> 4) Use of pressor agents in higher doses, further add to the renal insult.
> 5) Generally some patients would go through a period of severe oliguria or
> anuria before recovering to some extent.Some would require dialysis.(Your
> patient was on dialysis)
> 6) To over come the generally low output in these patients we are now
> liberally using hemofilteration during surgery on these paients.
> 7) I have also started to use IABP on any IDDM with abnormal serum
> creatinine and low EFs(even 35%-that I would not consider in a 
> non-diabetic
> pt) for a post op period of 24-36hrs.
> 8) Using IABP reduces the need for pressor agents that is helpful and in 
> our
> very limited experience provided adequate urine output.
> 9) I maintain the blood sugar in the initial periods to around 200 and 
> avoid
> large K supplements if possible.
> !0) Sometimes,even Heparin in the post operative period used in the 
> flushes
> causes inappropriate rise in serum K.Not too long ago Dr Prassana provided 
> a
> no.of referances for it.
>  Like I said these are obsevations and not necessarily an explantion to
> your patients demise.
> Shahid Malik
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