Ventricular tachycardia without preceding electrocardiogram change after hypertonic mannitol administration: a case
Akira Gohara1,2, Sumi Okamatsu-Kifuji1, Shinjiro Shono1
1Department of Anesthesiology, Fukuoka University Chikushi Hospital, Chikushino, Japan.
JA Clinical Reports
|February 7, 2020
Summary
Hypertonic mannitol can cause lethal arrhythmia, specifically ventricular tachycardia (VT), even without typical ECG changes. Physicians should be aware of this serious complication during neurosurgery.
Area of Science:
- Neurosurgery
- Cardiology
- Anesthesiology
Background:
- Mannitol is a common osmotic diuretic used in neurosurgery.
- A serious complication of mannitol is hyperkalemia, which can lead to lethal arrhythmias.
Purpose of the Study:
- To report a case of ventricular tachycardia (VT) occurring after hypertonic mannitol administration during neurosurgery.
- To highlight the potential for VT without preceding electrocardiogram (ECG) changes.
Main Methods:
- Case report of a 62-year-old male undergoing clipping of a cerebral artery aneurysm.
- Monitoring for adverse events following administration of 200 mL of 20% hypertonic mannitol.
- Management of hyperkalemia and ventricular tachycardia.
Main Results:
- Ventricular tachycardia (VT) occurred approximately 20 minutes after mannitol administration.
- No preceding ECG changes, such as peaked T waves, were observed.
- The patient's potassium level was 6.4 mEq/L, and VT resolved to sinus rhythm after chest compression and treatment with calcium gluconate, furosemide, and insulin with glucose.
Conclusions:
- Physicians must recognize that ventricular tachycardia (VT) can occur following hypertonic mannitol administration.
- This complication may manifest without typical preceding ECG changes.
- Awareness is crucial for prompt diagnosis and management of mannitol-induced hyperkalemia and arrhythmias.
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