Hyperkalemia is not an uncommon complication of cardiac surgical procedures. Intractable hyperkalemia is a difficult situation that can even lead to death. We report on a postoperative case in a patient in whom a sudden decrease of epinephrine led to intractable hyperkalemia and cardiac arrest. We wish to draw the reader's attention to the issue that sudden discontinuation of epinephrine can lead to dangerous hyperkalemia.
After sternotomy in a 65-year-old lady for elective coronary artery bypass grafting and mitral valve replacement, a soft 4 Â 2-cm mass was seen at right atrial-right ventricular junction, with thickened thymic tissue (Figure 1). A total thymectomy, biopsy of the mass, coronary artery bypass, and valve replacement were performed. The biopsy showed a secondary pericardial deposit with lymphoma of the thymus.
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