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Zheng H, Cao X, Gao F, Li X, Wan L, Luo A. Hyperkalemic cardiac arrest induced by mannitol administration during craniotomy: A case report and review of the literature. Front Surg 2022; 9:1019101. [PMID: 36303859 PMCID: PMC9592835 DOI: 10.3389/fsurg.2022.1019101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Mannitol is the most widely used hyperosmolar agent during neurosurgical procedures. However, its use can lead to serious hyperkalemia with altered cardiac conduction. Case presentation Here we report a case in which a 40-min cardiac arrest was caused by mannitol-induced hyperkalemia during craniotomy. In addition, we conducted a literature review through a PubMed (MEDLINE) search of the relevant literature published so far. Details of all cases are presented and discussed. The results suggest that male patients or patients with uncontrolled diabetes might be at higher risk to develop this phenomenon. The results also suggest that the high dose and rapid rate of infusion of mannitol might contribute to mannitol-induced hyperkalemia. Conclusion Physicians should be aware of the existence of mannitol-induced hyperkalemia. Although the mechanism of this complication is not well established, it is prudent to administer mannitol cautiously, especially in patients with uncontrolled diabetes. Continuous electrocardiogram monitoring and frequent measurements of serum electrolytes can help to detect and treat possible life-threatening events induced by mannitol-induced hyperkalemia early.
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Thapa N, Maharjan S, Hona A, Pandey J, Karki S. Spontaneous rupture of renal angiomyolipoma and its management: A case report. Ann Med Surg (Lond) 2022; 79:104037. [PMID: 35860139 PMCID: PMC9289389 DOI: 10.1016/j.amsu.2022.104037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022] Open
Abstract
a) Introduction and Importance Angiomyolipomas of kidney are benign lesions that are generally an incidental finding on imaging. Rupture of angiomyolipoma is rare and fatal complication that requires early intervention. b) Case Presentation A 38 year old male patient presented with symptoms of right flank pain for 2 days. On clinical examination patient looked anxious, pale with right flank tenderness, guarding and signs of shock. c) Clinical findings and investigations CT scan showed renal angiomyolipoma with aneurysm formation and bleed from the lesion. Blood profile revealed low hemoglobin. d) Interventions and Outcome Right nephrectomy performed along 6 cycles of cardiopulmonary reususcitaion done with stable post operatively vitals. e) Conclusion Early diagnosis of complication of angiomyolipoma requires thorough clinical examination and judicious use of imaging. Immediate embolization or surgery must be performed for better outcome and survival rate. Angiomyolipoma is composed of fat, smooth muscle and blood vessels and presents among 0.3% of the population. Renal angiomyolipoma are prone to aneurysm formation and bleed, however a nontraumatic spontaneous renal hemorrhage from a sporadic renal angiomyolipoma is a rare condition. Mostly angiomyolipoma are asymptomatic and are diagnosed incidentally. CT scan is the diagnostic modality of choice. Patients with life-threatening hemorrhage require immediate intervention that includes embolization or surgery for better outcome and survival rate.
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Potasso L, Refardt J, Chifu I, Fassnacht M, Fenske WK, Christ-Crain M. Incidence of hyperkalemia during hypertonic saline test for the diagnosis of diabetes insipidus. Endocr Connect 2021; 10:401-409. [PMID: 33666570 PMCID: PMC8133371 DOI: 10.1530/ec-20-0531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Hyperkalemia has been reported upon different hypertonic saline infusion protocols. Since hypertonic saline test has recently been validated for the differential diagnosis of diabetes insipidus (DI), we aimed to investigate the course of plasma potassium during the test. DESIGN We analyzed data of 90 healthy volunteers and 141 patients with polyuria-polydipsia syndrome (PPS) from two prospective studies evaluating the hypertonic saline test. Our primary outcome was the incidence rate of hypertonic saline-induced hyperkalemia > 5 mmol/L. METHODS Participants received a 250 mL bolus of 3% NaCl solution, followed by 0.15 mL/min/kg body weight continuously infused targeting a plasma sodium level of 150 mmol/L. Blood samples and clinical data were collected every 30 min. RESULTS Of the 231 participants, 16% (n = 37/231) developed hyperkalemia. The incidence of hyperkalemia was higher in healthy volunteers and in patients with primary polydipsia (25.6% (n = 23/90) and 9.9% (n = 14/141), respectively), and only occurred in 3.4% (n = 2/59) of patients with diabetes insipidus. Hyperkalemia developed mostly at or after 90-min test duration (81.1%, n => 30/37). Predictors of hyperkalemia (OR (95% CI)) were male sex (2.9 (1.2-7.4), P => 0.02), a plasma potassium at baseline > 3.9 mmol/L (5.2 (1.8-17.3), P => 0.004), normonatremia at 30-min test duration (3.2 (1.2-9.5), P => 0.03), and an increase in potassium levels already at 30-min test duration as compared to baseline (4.5 (1.7-12.3), P => 0.003). Hyperkalemia was transient and resolved spontaneously in all cases. CONCLUSION The hypertonic saline test can lead to hyperkalemia, especially in patients with primary polydipsia who experience a longer test duration. Monitoring potassium levels in these patients is recommended.
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Affiliation(s)
- Laura Potasso
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Correspondence should be addressed to L Potasso:
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Irina Chifu
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg Germany
- Central Laboratory, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Wiebke Kristin Fenske
- Integrated Research and Treatment Center for Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Schwimmbeck F, Voellger B, Chappell D, Eberhart L. Hypertonic Saline Versus Mannitol for Traumatic Brain Injury: A Systematic Review and Meta-analysis With Trial Sequential Analysis. J Neurosurg Anesthesiol 2021; 33:10-20. [PMID: 31567726 DOI: 10.1097/ana.0000000000000644] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mannitol and hypertonic saline are widely used to treat raised intracranial pressure (ICP) after traumatic brain injury (TBI), but the clinical superiority of one over the other has not been demonstrated. METHODS According to the PRISMA statement, this meta-analysis reports on randomized controlled trials investigating hypertonic saline compared with mannitol in the treatment of elevated ICP following TBI. The protocol for the literature searches (Medline, Embase, Central databases), quality assessment, endpoints (mortality, favorable outcome, brain perfusion parameters), and statistical analysis plan (including a trial sequential analysis) were prospectively specified and registered on the PROSPERO database (CRD42017057112). RESULTS A total of 12 randomized controlled trials with 464 patients were eligible for inclusion in this analysis. Although there was a nonsignificant trend in favor of hypertonic saline, there were no significant differences in mortality between the 2 treatments (relative risk [RR]: 0.69, 95% confidence interval [CI]: 0.45, 1.04; P=0.08). There were also no significant differences in favorable neurological outcome between hypertonic saline (HS) and mannitol (RR: 1.28, 95% CI: 0.86, 1.90; P=0.23). There was no difference in ICP at 30 to 60 minutes after treatment (mean difference [MD]: -0.19 mm Hg, 95% CI: -0.54, 0.17; P=0.30), whereas ICP was significantly lower after HS compared with mannitol at 90 to 120 minutes (MD: -2.33 mm Hg, 95% CI: -3.17, -1.50; P<0.00001). Cerebral perfusion pressure was higher between 30 to 60 and 90 to 120 minutes after treatment with HS compared with after treatment with mannitol (MD: 5.48 mm Hg, 95% CI: 4.84, 6.12; P<0.00001 and 9.08 mm Hg, 95% CI: 7.54, 10.62; P<0.00001, respectively). Trial sequential analysis showed that the number of cases was insufficient to produce reliable statements on long-term outcomes. CONCLUSION There are indications that HS might be superior to mannitol in the treatment of TBI-related raised ICP. However, there are insufficient data to reach a definitive conclusion, and further studies are warranted.
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Affiliation(s)
- Franz Schwimmbeck
- Department of Anaesthesiology, University Hospital of Munich (LMU), Marchioninistr, Munich
| | | | - Daniel Chappell
- Department of Anaesthesiology, University Hospital of Munich (LMU), Marchioninistr, Munich
| | - Leopold Eberhart
- Anesthesiology and Intensive Care Therapy, Philipps University Marburg, Baldingerstr, Marburg, Germany
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Zhang W, Neal J, Lin L, Dai F, Hersey DP, McDonagh DL, Su F, Meng L. Mannitol in Critical Care and Surgery Over 50+ Years: A Systematic Review of Randomized Controlled Trials and Complications With Meta-Analysis. J Neurosurg Anesthesiol 2019; 31:273-284. [DOI: 10.1097/ana.0000000000000520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Can we predict who will develop postoperative hyperkalaemia after parathyroidectomy in dialysis patients with secondary hyperparathyroidism? BMC Nephrol 2019; 20:225. [PMID: 31221111 PMCID: PMC6585140 DOI: 10.1186/s12882-019-1416-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyperkalaemia occurs frequently in many maintenance haemodialysis (MHD) patients after parathyroidectomy (PTX) with secondary hyperparathyroidism (SHPT). However, the clinical risk factors that predict postoperative hyperkalaemia are uncertain. METHODS This retrospective cohort study included 90 maintenance haemodialysis patients aged ≥18 years who underwent PTX between April 2011 and April 2016 at Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine). Pre- and post-PTX surgery venous samples were measured in quadruplicate. We examined univariate associations with demographics, dialysis characteristics, laboratory values and medications. Hyperkalaemia was defined as serum potassium >5.3 mmol/L. RESULTS Out of nighty patients, twenty-two (24.4%) developed postoperative hyperkalaemia, of whom sixteen (18.1%) developed hyperkalaemia on postoperative day 3. The univariate analysis showed that weight, dialysis duration, preoperative serum potassium, alkaline phosphate, triglyceride, and postoperative alkaline phosphate were independently associated with hyperkalaemia after parathyroidectomy. The univariate logistic regression model showed that preoperative serum potassium was the only independent factor that could predict hyperkalaemia after parathyroidectomy (odds ratio, 1.59; 95% confidence interval, 1.24-2.05). The optimal cut-off for pre-operative K was 3.9 mmol/L according to the receiver operating characteristic (ROC) curve. A higher incidence of postoperative hyperkalaemia was found in male and younger patients, but the difference was not statistically significant (p>0.05). CONCLUSIONS Pre-operative serum potassium less than 3.9 mmol/L was associated with less hyperkalaemia post-operatively in end-stage renal disease (ESRD) patients undergoing PTX.
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Gohara A, Okamatsu-Kifuji S, Shono S, Higashi M, Yamaura K. Ventricular tachycardia without preceding electrocardiogram change after hypertonic mannitol administration: a case report. JA Clin Rep 2018; 4:54. [PMID: 32026957 PMCID: PMC6967028 DOI: 10.1186/s40981-018-0191-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background Mannitol is widely used during neurosurgery, but it has a serious complication including lethal arrhythmia due to mannitol-induced hyperkalemia. Case presentation We report on a 62-year-old man scheduled for the clipping of an unruptured cerebral artery aneurysm. During surgery, approximately 20 min after the end of 200-mL 20% hypertonic mannitol administration, ventricular tachycardia (VT) occurred without preceding electrocardiogram (ECG) change, such as peaked T waves, and VT was recovered to sinus rhythm after chest compression. A potassium concentration after recovery from VT was 6.4 mEq/L, which was normalized by the administration of calcium gluconate, furosemide, and insulin with glucose. Conclusions Physicians must be aware that VT without preceding ECG change can occur after hypertonic mannitol administration.
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Affiliation(s)
- Akira Gohara
- Department of Anesthesiology, Fukuoka University Chikushi Hospital, Chikushino, Japan.,Department of Anesthesiology, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Sumi Okamatsu-Kifuji
- Department of Anesthesiology, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Shinjiro Shono
- Department of Anesthesiology, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Midoriko Higashi
- Department of Anesthesiology, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ken Yamaura
- Department of Anesthesiology, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Seo H, Kim E, Jung H, Lim YJ, Kim JW, Park CK, Se YB, Jeon YT, Hwang JW, Park HP. A prospective randomized trial of the optimal dose of mannitol for intraoperative brain relaxation in patients undergoing craniotomy for supratentorial brain tumor resection. J Neurosurg 2016; 126:1839-1846. [DOI: 10.3171/2016.6.jns16537] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEMannitol is used intraoperatively to induce brain relaxation in patients undergoing supratentorial brain tumor resection. The authors sought to determine the dose of mannitol that provides adequate brain relaxation with the fewest adverse effects.METHODSA total of 124 patients were randomized to receive mannitol at 0.25 g/kg (Group A), 0.5 g/kg (Group B), 1.0 g/kg (Group C), and 1.5 g/kg (Group D). The degree of brain relaxation was classified according to a 4-point scale (1, bulging; 2, firm; 3, adequate; and 4, perfectly relaxed) by neurosurgeons; Classes 3 and 4 were considered to indicate satisfactory brain relaxation. The osmolality gap (OG) and serum electrolytes were measured before and after mannitol administration.RESULTSThe brain relaxation score showed an increasing trend in patients receiving higher doses of mannitol (p = 0.005). The incidence of satisfactory brain relaxation was higher in Groups C and D than in Group A (67.7% and 64.5% vs 32.2%, p = 0.011 and 0.022, respectively). The incidence of OG greater than 10 mOsm/kg was also higher in Groups C and D than in Group A (100.0% in both groups vs 77.4%, p = 0.011 for both). The incidence of moderate hyponatremia (125 mmol/L ≤ Na+ < 130 mmol/L) was significantly higher in Group D than in other groups (38.7% vs 0.0%, 9.7%, and 12.9% in Groups A, B, and C; p < 0.001, p = 0.008, and p = 0.020, respectively). Hyperkalemia (K+ > 5.0 mmol/L) was observed in 12.9% of patients in Group D only.CONCLUSIONSThe higher doses of mannitol provided better brain relaxation but were associated with more adverse effects. Considering the balance between the benefits and risks of mannitol, the authors suggest the use of 1.0 g/kg of intraoperative mannitol for satisfactory brain relaxation with the fewest adverse effects.Clinical trial registration no.: NCT02168075 (clinicaltrials.gov)
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Affiliation(s)
- Hyungseok Seo
- Departments of 1Anesthesiology and Pain Medicine and
| | - Eugene Kim
- 2Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Catholic University of Daegu; and
| | - Haesun Jung
- Departments of 1Anesthesiology and Pain Medicine and
| | - Young-Jin Lim
- Departments of 1Anesthesiology and Pain Medicine and
| | - Jin Wook Kim
- 3Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul
| | - Chul-Kee Park
- 3Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul
| | - Young-Bem Se
- 3Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul
| | - Young-Tae Jeon
- 4Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam, Korea
| | - Jung-Won Hwang
- 4Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam, Korea
| | - Hee-Pyoung Park
- 4Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam, Korea
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Fanous AA, Tick RC, Gu EY, Fenstermaker RA. Life-Threatening Mannitol-Induced Hyperkalemia in Neurosurgical Patients. World Neurosurg 2016; 91:672.e5-9. [DOI: 10.1016/j.wneu.2016.04.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
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Oberoi RK, Parrish KE, Sio TT, Mittapalli RK, Elmquist WF, Sarkaria JN. Strategies to improve delivery of anticancer drugs across the blood-brain barrier to treat glioblastoma. Neuro Oncol 2015; 18:27-36. [PMID: 26359209 DOI: 10.1093/neuonc/nov164] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/15/2015] [Indexed: 12/21/2022] Open
Abstract
Glioblastoma (GBM) is a lethal and aggressive brain tumor that is resistant to conventional radiation and cytotoxic chemotherapies. Molecularly targeted agents hold great promise in treating these genetically heterogeneous tumors, yet have produced disappointing results. One reason for the clinical failure of these novel therapies can be the inability of the drugs to achieve effective concentrations in the invasive regions beyond the bulk tumor. In this review, we describe the influence of the blood-brain barrier on the distribution of anticancer drugs to both the tumor core and infiltrative regions of GBM. We further describe potential strategies to overcome these drug delivery limitations. Understanding the key factors that limit drug delivery into brain tumors will guide future development of approaches for enhanced delivery of effective drugs to GBM.
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Affiliation(s)
- Rajneet K Oberoi
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (R.K.O., K.E.P., R.K.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (T.T.S., J.N.S.)
| | - Karen E Parrish
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (R.K.O., K.E.P., R.K.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (T.T.S., J.N.S.)
| | - Terence T Sio
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (R.K.O., K.E.P., R.K.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (T.T.S., J.N.S.)
| | - Rajendar K Mittapalli
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (R.K.O., K.E.P., R.K.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (T.T.S., J.N.S.)
| | - William F Elmquist
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (R.K.O., K.E.P., R.K.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (T.T.S., J.N.S.)
| | - Jann N Sarkaria
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (R.K.O., K.E.P., R.K.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (T.T.S., J.N.S.)
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Yang YL, Lu HF, Chung KC, Jawan B, Chou FF. Young age, male sex, and end-stage renal disease with secondary hyperparathyroidism as risk factors for intraoperative hyperkalemia during parathyroidectomy. J Clin Anesth 2014; 27:195-200. [PMID: 25434503 DOI: 10.1016/j.jclinane.2014.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 05/17/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to investigate the risk factors of intraoperative hyperkalemia in end-stage renal disease patients undergoing parathyroidectomy (PTx) with autotransplantation (AT). DESIGN Prospective observational study. SETTING Operating room of a tertiary care medical center. PATIENTS Thirty-two adult, American Society of Anesthesiologists physical status 2 and 3 patients with secondary hyperparathyroidism aged between 31 and 72 years scheduled for PTx with AT. MEASUREMENTS Laboratory chemistries (intact parathyroid hormone, Na, K, Ca, P, arterial blood gas) were obtained before surgery and at 2 time points during surgery. The first chemistry levels during surgery were checked after the first 2 parathyroid glands had been removed, and the second levels were checked after wound closure. Statistical analysis was performed using t test, Fisher exact test, the receiver operating characteristic curve method, as appropriate. MAIN RESULTS Eight patients (25%) developed hyperkalemia during surgery. The hyperkalemia patients had younger age (42±11.44 years vs 52.58±11.83 years, P=.044) and a male dominance (odds ratio, 11.4; P=.01; 95% confidence interval, 1.74-74.65). The cutoff for age was 40.5 years, according to the highest value for sensitivity plus specificity of the receiver operating characteristic curve. There was a higher incidence of intraoperative hyperkalemia in younger patients than in older patients (odds ratio, 8.33; P=.023; 95% confidence interval, 1.39-49.87) as well as a significant increase in potassium level during surgery in younger male patients (P=.005 and .002, respectively). CONCLUSIONS The anesthesiologist should be aware of the complications of intraoperative hyperkalemia during PTx with AT, especially in male end-stage renal disease patients younger than 40 years.
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Affiliation(s)
- Ya-Ling Yang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Hsiao-Feng Lu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Kuan-Chih Chung
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Bruno Jawan
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Fong-Fu Chou
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
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Berkova M, Berka Z, Topinkova E. Arrhythmias and ECG changes in life threatening hyperkalemia in older patients treated by potassium sparing drugs. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:84-91. [DOI: 10.5507/bp.2012.087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Indexed: 11/23/2022] Open
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Sharma J, Salhotra R. Mannitol-induced intraoperative hyperkalemia, a little-known clinical entity. J Anaesthesiol Clin Pharmacol 2012; 28:546-7. [PMID: 23225957 PMCID: PMC3511974 DOI: 10.4103/0970-9185.101965] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jp Sharma
- Dept of Anaesthesiology and Critical Care, UCMS and GTB Hospital, Delhi, India
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Alterations in Serum Osmolality, Sodium, and Potassium Levels After Repeated Mannitol Administration. J Neurosci Nurs 2010; 42:201-7. [DOI: 10.1097/jnn.0b013e3181e26b4a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kolsen-Petersen JA, Nielsen JOD, Tonnesen E. Acid base and electrolyte changes after hypertonic saline (7.5%) infusion: A randomized controlled clinical trial. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 65:13-22. [PMID: 15859023 DOI: 10.1080/00365510410003138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hypertonic saline solutions are effective in the treatment of haemorrhagic and septic shock, elevated intracranial pressure and perioperative fluid deficits. Infusion, however, causes electrolyte and acid-base imbalance. In a randomized double-blind study, the effects of a 10-min infusion of 4 ml/kg 7.5% NaCl or 0.9% NaCl were evaluated in 14 fasting women before hysterectomy. Venous blood from the forearm was collected at baseline, 10, 20, 30, 60 and 120 min after start of the infusion for the determination of plasma electrolytes and acid-base balance. We found that 1) a median increase in plasma sodium of 11 mmol/l (range 9-13 mmol/l) and chloride of 14 mmol/l (range 9-16 mmol/l) immediately after the infusion followed by a small decrease after 2 h, 2) a minor decrease in plasma potassium in relation to the infusion followed by a significant increase of 0.3 mmol/l (range 0.1-1.4 mmol/l) above baseline after 1 h, 3) a decrease in pH of 0.05 (range 0.02-0.07) and, finally, 4) a decrease in base excess of 1.9 mmol/l (range 0.8-2.7 mmol/l). It is concluded that infusion of 7.5% NaCl in a clinical relevant dose increases plasma potassium and causes minor changes in the acid-base balance in normovolaemic women.
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Affiliation(s)
- J A Kolsen-Petersen
- Department of Anaesthesia and Intensive Care, Viborg County Hospital, Viborg, Denmark.
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Flynn BC. Hyperkalemic Cardiac Arrest with Hypertonic Mannitol Infusion: The Strong Ion Difference Revisited. Anesth Analg 2007; 104:225-6. [PMID: 17179295 DOI: 10.1213/01.ane.0000249801.01029.55] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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