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Refractory hypokalemia during barbiturate coma therapy used for treating refractory intracranial hypertension in

Wan Mohd Nazaruddin Wan Hassan1, Nazuha Mohd Najid1, Halimatun Sa'adiah Muslim1

  • 1Department of Anaesthesiology, School of Medical Sciences and P3 Neuro Center, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Asian Journal of Neurosurgery
|March 14, 2015
PubMed

Insights

Barbiturate coma therapy can cause dangerous low potassium levels. This case report details managing this rare complication in a patient undergoing thiopentone treatment for high intracranial pressure.

Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Pharmacology

Background:

  • Barbiturate coma therapy (BCT) is a critical intervention for refractory intracranial hypertension (ICP) when standard treatments fail.
  • BCT effectively reduces cerebral blood flow, oxygen consumption, and ICP.
  • However, BCT is associated with significant complications, including electrolyte imbalances.

Observation:

  • Refractory hypokalemia (low potassium) is an underreported yet life-threatening complication of BCT.
  • This complication can paradoxically lead to hyperkalemia (high potassium) upon abrupt discontinuation of the therapy.
  • We present a case of managing refractory hypokalemia during thiopentone-induced BCT in a patient who underwent decompressive craniectomy.

Findings:

  • The patient developed persistent hypokalemia requiring intensive management.
  • Careful monitoring and electrolyte correction were crucial to prevent rebound hyperkalemia.
  • Successful management involved a tailored approach to BCT and potassium replacement.

Implications:

  • Highlights the importance of vigilant electrolyte monitoring during BCT.
  • Suggests a need for standardized protocols for managing hypokalemia in patients receiving BCT.
  • Informs clinical practice regarding the safe use of thiopentone for intracranial pressure management.

Keywords:
Barbiturate comahypokalemiaintracranial hypertensiontraumatic brain injury

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