a young male patient with rheumatic mitral valve disease underwent a valve replacement surgery.His baseline creatinine is 1.2 mg/dl, and border line cardiac function with ejection fraction of 45% ,the valve was prosthetic valve with bypass procedure for 9 hours.. Everything went smooth without any complications intraoperatively.In the very next day he developed a severe hyperkalemia of 7 meg/l, his creatinine went up to 1.6 mg/dl, with good urine output . He was aggressively diuresed for volume overload with lasix leading to polyuria and creatnine jumped up to 2.5 mg/dl on the next day, Despite the polyuria and mild renal impairment on a background of stable hemodynamic status, he developed serum K of 7 Meg/l !!!!.He required the initiation of CRRT due to vasopressor dependence.There is no evidence of hemolysis and other electrolytes are within normal.he is on heparin and CPK is 8000.
Is the CRRT indicated in the situation of mild renal impairment and polyuria??
what could be the causes of hyperkalemia?
your response is appreciated
Cardioplegic solution used in open heart surgery is K+ based. You could face such severe hyperkalemia out of proportion to sCr. If that’s not what your CT surgeons used then you may consider (IRI) ischemic reperfusion injury too, and down that line check CPK and lactate, etc. Also Was Propofol used for induction or sedation? Could this be a case of propofol-induced rhabdo? How much blood transfusion he received during surgery? Large load of blood would be a potential cause for hyperkalemia
Looks like rhabdomyolysis with a marked release of intra-cellular Potassium. Does he have myoglobinuria?. Rarely heparin can cause a transient hypo-adrenalism, impairing potassium excretion with acute potassium loading.Even SQ heparin has been shown to inhibit aldo release stimulated by renin.