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[Atrial arrest and intraventricular conduction disorders due to accidental hyperkalemia during kidney
Insights
End-stage renal disease patients can develop hyperkalemia, a dangerous electrolyte disturbance. This case report details a kidney transplant patient who experienced severe hyperkalemia, leading to critical ECG changes, and was successfully treated.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Electrolyte disturbances, particularly hyperkalemia, are significant complications in end-stage renal disease (ESRD).
- Hyperkalemia can severely impact cardiac function, affecting pacemaker cells and myocardial conduction.
- Understanding ECG manifestations and management is crucial for patient outcomes.
Observation:
- A 64-year-old male with chronic renal failure presented for kidney transplantation.
- Intraoperative complications, including prolonged arterial cross-clamping, led to a significant increase in plasma potassium.
- Post-declamping, the patient exhibited ECG changes characteristic of severe hyperkalemia, including atrial arrest and AV dissociation.
Findings:
- Plasma potassium levels rose from a normal preoperative range to 6.77 mmol/l, correlating with the observed ECG abnormalities.
- Immediate treatment with calcium gluconate, sodium bicarbonate, and glucose-insulin infusion rapidly normalized potassium levels and restored sinus rhythm.
- Despite the critical ECG changes, the patient's cardiovascular status remained stable throughout the event.
Implications:
- This case highlights the critical importance of vigilant electrolyte monitoring during major surgical procedures in ESRD patients.
- Prompt recognition and aggressive management of hyperkalemia are essential to prevent life-threatening cardiac events.
- The successful intervention underscores the efficacy of standard treatment protocols for acute hyperkalemia in high-risk surgical settings.
Abstract:
Besides anemia, coagulopathies, and hypertension, electrolyte disturbances are among the most significant features of end-stage renal disease. Although plasma potassium represents only 1.5%-2% of the whole-body content, hyperkalemia has definite effects on cardiac pacemaker cells and myocardial conduction. The typical ECG findings and therapeutic management will be discussed. Case report. A 64-year-old man with chronic renal failure due to phenacetin abuse was scheduled for transplantation of a 41-h-old cadaver kidney. The preoperative laboratory check revealed BUN 51 mg% and creatinine 11.5 mg%; serum sodium and potassium were within normal limits (sodium 141 mmol/l, potassium 5.11 mmol/l). A central-venous blood gas sample after induction of anesthesia and intubation revealed pH of 7.32, pCO2 43 mmHg, HCO3 22.1 mmol/l, base excess - 3.4 mmol/l, and venous oxygen saturation 84%. Plasma potassium (5.22 mmol/l) was within the normal range. As an endarterectomy of the left common and external iliac arteries had to be performed, the arterial cross-clamping time was longer than normal (73 min). After declamping an ECG pattern (modified V5 lead) typical of hyperkalemia (atrial arrest, idioventricular rhythm, right bundle-branch block-like QRS, AV dissociation, AV block I) was observed. Plasma potassium had increased to 6.77 mmol/l (+1.55 mmol/l). Immediate treatment was started with a bolus injection of 20 ml 10% calcium gluconate, rapid infusion of 200 ml 8.4% sodium bicarbonate, and glucose-insulin infusion (glucose 33 1/3%, 15 U regular insulin). After 25 min sinus rhythm was restored and potassium levels decreased to normal. Despite the observed ECG changes the cardiovascular status remained stable.(ABSTRACT TRUNCATED AT 250 WORDS)