Propofol Induced Hyperkalemia and Its Management in End Stage Renal Disease Patients

Propofol related infusion syndrome (PRIS) is a rare, but extremely dangerous complication of propofol administration. Unexplained anion-gap metabolic acidosis, rhabdomyolysis, hyperkalemia, acute kidney injury, elevated liver enzymes, and potentially fatal cardiac arrhythmias are characteristic of PRIS. Risk factors for the develop- ment of PRIS include dose and duration of propofol infusion, severe illness, and concomitant administration of catecholamine and glucocorticoids. PRIS causing hyperkalemia is a well-known clinical entity. Although the development of PRIS depends on the duration and total amount of drug infused, repeated boluses of propofol, commonly used for rapid sequence intubation and conscious sedation, can potentially precipitate fatal hyperkalemia. This is of particular concern in advanced chronic kidney disease (CKD) and end stage renal disease (ESRD) patients. We report a case of a propofol induced hyperkalemia causing near fatal cardiac arrhythmia in a dialysis dependent ESRD patient. We report successful revival from cardiac arrest by intensive calcium regimen and hemodialysis. This case highlights underrecognized problem of propofol-induced hy- perkalemia, which can be of particular concerns in advanced CKD and ESRD.