[HSF] Hyperkalemia

Mon Apr 2 09:15:37 EDT 2007

The patient surived. The K went up to 6.8 despite dialysis and came down
within 4 hours after stopping all Heparin. After one day we gave a test odse
of heparin which produced hyperkalemia again.
Prasanna

On 4/2/07, A <alsadd at ksu.edu.sa> wrote:
>
> 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.Dialysisusually
> > 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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-- 
Prasanna Simha M