[HSF] Hyperkalemia

Thu Apr 5 19:25:37 EDT 2007

I would think an unattended patient would rise quickly to the levels (we 
had a glucose Insulin infusion + pottasium binding resin) on in addition 
to peritoneal dialysis.
If you go to emedicine.com and go through their exhaustive list on 
hyperkalemia, it will help.
Prasanna

A wrote:
> In my cases it went to more than 7 even to 8 in one of them. It was fatal.
> Can you think of another mechanism other than the heparin?
> 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 11:16 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Hyperkalemia
>
> 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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