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Hyperkalemia. A prognostic factor during acute severe hypothermia.
M D Schaller1, A P Fischer, C H Perret
1Department of Medicine, University Hospital, Lausanne, Switzerland.
JAMA
|October 10, 1990
Summary
Extreme hyperkalemia, a dangerous rise in blood potassium, indicates death in hypothermia patients. This finding helps determine when resuscitation efforts are futile for avalanche victims, distinguishing them from drug-intoxicated patients.
Area of Science:
- Emergency Medicine
- Toxicology
- Physiology
Background:
- Determining death in hypothermic patients is challenging due to a lack of reliable indicators.
- Hypothermia can result from environmental exposure (e.g., avalanches) or drug intoxication.
Purpose of the Study:
- To identify prognostic indicators for hypothermic patients.
- To differentiate between fatal and potentially survivable hypothermia cases.
Main Methods:
- Retrospective review of hospital charts for two groups of hypothermic patients: avalanche victims (Group A) and those with drug intoxication/cold exposure (Group B).
- Analysis of admission plasma potassium levels and resuscitation outcomes.
Main Results:
- Avalanche victims (Group A) had extremely high admission plasma potassium levels (median 14.5 mmol/L) and all were in cardiorespiratory arrest, with no successful resuscitations.
- Patients with hypothermia from drug intoxication/cold exposure (Group B) had normal potassium levels (median 3.5 mmol/L), and all recovered, including two from cardiorespiratory arrest.
Conclusions:
- Extreme hyperkalemia (high plasma potassium) is a reliable marker of death in acute hypothermia.
- This marker can guide decisions regarding the futility of aggressive resuscitation efforts in severe hypothermia cases.