[HSF] Hyperkalemia

[A]

Prasanna:
You are still out of your base but keeping up with HSF; this is great. I
wish you a save return. I was waiting for your input on this issue. Did you
publish your case report? How high did the serum K get to? Did the patient
made it? A lot of questions sorry about that but because I had three such
cases over a period of years I would like to collect data for I may just
write it up. 
Thanks  

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Prasanna Simha M
Sent: Sunday, April 01, 2007 10:13 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Hyperkalemia

I had presented such a case some time back which was also PD nonresponsive
till we stopped Heparin
Prasanna from Zagreb.


On 4/1/07, Shahid Mahmud Malik <smmalik at brain.net.pk> wrote:
>
> 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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-- 
Prasanna Simha M
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