Acute and Critical Care

  • 제33권4호
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  • Pages.271-275
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  • 2018
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  • 2586-6052(pISSN)
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  • 2586-6060(eISSN)
대한중환자의학회 (Korean Society of Critical Care Medicine)
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Sudden Intraoperative Hyperkalemia during Laparoscopic Radical Nephrectomy in a Patient with Underlying Renal Insufficiency

  • Jung, Sung Hoon (Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea) ;
  • Han, Yun-Joung (Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea) ;
  • Shin, Sang Ho (Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea) ;
  • Lee, Hyo Seon (Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea) ;
  • Lee, Ji Young (Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea)
  • 투고 : 2016.08.08
  • 심사 : 2016.10.14
  • 발행 : 2018.11.30
⟨ 이전 논문 다음 논문 ⟩

초록

We experienced a case of severe intraoperative hyperkalemia during laparoscopic radical nephrectomy in a 60-year-old male patient with renal insufficiency, whose hypertension had been managed by preoperative angiotensin II receptor blocker (ARB) and adrenergic beta-antagonist. After renal vessel ligation, his intraoperative potassium concentration suddenly increased to 7.0 mEq/L, but his electrocardiography (ECG) did not show any significant change. While preoperative ARB therapy has been regarded as a contributing factor for further aggravation of underlying renal insufficiency, we assumed that nephrectomy itself and rhabdomyolysis caused by surgical trauma also aggravated the underlying renal dysfunction and resulted in sudden hyperkalemia. Hyperkalemia was managed successfully with calcium gluconate, insulin, furosemide and crystalloid loading during the intraoperative and immediate postoperative periods, and potassium concentration decreased to 5.0 mEq/L at 8 hours after the operation. The patient's hospital course was uncomplicated, but his renal function deteriorated further.

키워드

참고문헌

  1. Acker CG, Johnson JP, Palevsky PM, Greenberg A. Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. Arch Intern Med 1998;158:917-24. https://doi.org/10.1001/archinte.158.8.917
  2. Eliacik E, Yildirim T, Sahin U, Kizilarslanoglu C, Tapan U, Aybal-Kutlugun A, et al. Potassium abnormalities in current clinical practice: frequency, causes, severity and management. Med Princ Pract 2015;24:271-5. https://doi.org/10.1159/000376580
  3. Rimmer JM, Horn JF, Gennari FJ. Hyperkalemia as a complication of drug therapy. Arch Intern Med 1987;147:867-9. https://doi.org/10.1001/archinte.1987.00370050063011
  4. Ayach T, Nappo RW, Paugh-Miller JL, Ross EA. Postoperative hyperkalemia. Eur J Intern Med 2015;26:106-11. https://doi.org/10.1016/j.ejim.2015.01.010
  5. Shemer J, Modan M, Ezra D, Cabili S. Incidence of hyperkalemia in hospitalized patients. Isr J Med Sci 1983;19:659-61.
  6. Grande Villoria J, Macias Nunez JF, Miralles JM, De Castro del Pozo S, Tabernero Romo JM. Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure. Am J Nephrol 1988;8:127-37. https://doi.org/10.1159/000167571
  7. Schaefer TJ, Wolford RW. Disorders of potassium. Emerg Med Clin North Am 2005;23:723-47. https://doi.org/10.1016/j.emc.2005.03.016
  8. Raebel MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Cardiovasc Ther 2012;30:e156-66. https://doi.org/10.1111/j.1755-5922.2010.00258.x
  9. Park I, Sheen SS, Lim HS, Yoon D, Park MY, Lee SH, et al. Comparison of hyperkalemic risk in hospitalized patients treated with different angiotensin receptor blockers: a retrospective cohort study using a Korean clinical research database. Am J Cardiovasc Drugs 2012;12:255-62. https://doi.org/10.1007/BF03261834
  10. Hahn L, Hahn M. Carvedilol-induced hyperkalemia in a patient with chronic kidney disease. J Pharm Pract 2015;28:107. https://doi.org/10.1177/0897190014566306
  11. Khosla N, Kalaitzidis R, Bakris GL. Predictors of hyperkalemia risk following hypertension control with aldosterone blockade. Am J Nephrol 2009;30:418-24. https://doi.org/10.1159/000237742
  12. van Dellen D, Tavakoli A, Wadsworth R, Augustine T. Intraoperative hyperkaliemia complicating hand-assisted live-donor nephrectomy. Exp Clin Transplant 2011;9:417-20.
  13. Pariser JJ, Pearce SM, Patel SG, Anderson BB, Packiam VT, Shalhav AL, et al. Rhabdomyolysis after major urologic surgery: epidemiology, risk factors, and outcomes. Urology 2015;85:1328-32. https://doi.org/10.1016/j.urology.2015.03.018
  14. Parham WA, Mehdirad AA, Biermann KM, Fredman CS. Hyperkalemia revisited. Tex Heart Inst J 2006;33:40-7.
  15. Kline JA, Weisberg LS. Acid-base, electrolyte, and metabolic abnormalities. In: Parrillo JE, Dellinger RP, editors. Critical care medicine: principles of diagnosis and management in the adult. 4th ed. Philadelphia: Elsevier Saunders; 2014. p. 993-1028.