Hyperkalaemia during massive blood transfusion in paediatric craniofacial surgery

Brown, Karen; Bissonnette, Bruno; MacDonald, Maureen; Poon, Annette

doi:10.1007/bf03005615

Cited by 59 publications

(46 citation statements)

References 23 publications

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“…Although we did not routinely measure the potassium concentration from our stored or fresh blood products, the exogenous potassium load from a unit of PRBC is thought to increase as shelf life increases; because of the need to store continuously massive quantities of PRBC and challenges in shipping from US-based sources to locations within the theater of operations in Iraq, the average shelf life of a unit of PRBC is between 30 and 35 d at our hospital. Brown et al (16) showed that the amount of potassium that is contained in the small plasma component of a stored unit of PRBC seems to plateau at approximately 20 d and averages Ͼ3.7 mmol at this time, representing a clinically significant source of exogenous potassium if multiple units are given. However, as these authors pointed out, there is wide variability in the plasma potassium concentration of stored PRBC, independent of shelf life.…”

Section: Discussionmentioning

confidence: 99%

Resuscitative Hyperkalemia in Noncrush Trauma

Perkins¹,

Aboudara²,

Abbott³

et al. 2007

Clinical Journal of the American Society of Nephrology

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The trauma patient is exposed to physiologic processes and life-saving interventions that predispose to hyperkalemia. Severe elevations in potassium levels subject this compromised patient to additional cardiac risks in the periresuscitative period. Recent advances in the care of the massively traumatized patient may or may not increase the risk for hyperkalemia. This prospective, observational study was undertaken to define the period prevalence of hyperkalemia (plasma potassium level >5.5 mmol/L) in a noncrush trauma population during the initial resuscitative period and to identify potential risk factors for the development of hyperkalemia. A total of 131 patients were studied during the initial 12 h after admission for noncrush trauma. The period prevalence of hyperkalemia was 29.0%. Hyperkalemic patients had dramatic shifts in plasma potassium levels compared with nonhyperkalemic patients. Five patients, all from the hyperkalemic group, died. By multivariate logistic regression analysis, independent risk factors for hyperkalemia were an emergency department plasma potassium level of 4.0 mmol/L or higher (relative risk 3.40; 95% confidence interval 1.17 to 9.84; P ‫؍‬ 0.024 versus baseline potassium level <4.0 mmol/L) and transfusion of cell-or plasma-based products (relative risk 10.56; 95% confidence interval 3.62 to 30.78; P < 0.001 per log-transformed unit). The prevalence of hyperkalemia during trauma resuscitation was not reported previously. Given the arrhythmic risks of hyperkalemia, particular caution is necessary with trauma patients who present with plasma potassium levels >4.0 mmol/L and require aggressive transfusion support.

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Section: Discussionmentioning

confidence: 99%

Resuscitative Hyperkalemia in Noncrush Trauma

Perkins¹,

Aboudara²,

Abbott³

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…It is estimated that the potassium load of transfused blood is redistributed within 30 min [11] but this is dependent upon several variables such as circulating blood volume and cardiac output [12], site of administration and acid base status.…”

Section: Discussionmentioning

confidence: 99%

‘Near‐miss’ hyperkalaemic cardiac arrest associated with rapid blood transfusion

Carvalho

Quiney

1999

Anaesthesia

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SummaryA case is presented in which a relatively modest blood transfusion resulted in acute hyperkalaemia with a 'near-miss' cardiac arrest. While transfusion-related hyperkalaemia usually occurs in association with massive transfusions, several factors may have increased the risk of such an acute reaction. A high index of suspicion is required, especially in patients with risk factors. Anaesthetists should not be lulled into a false sense of security simply because modest volumes of blood are being transfused. Hyperkalaemia is an established complication of blood transfusions. Most cases of significant hyperkalaemia and cardiac arrest have involved neonates [1] or adults receiving massive transfusion [2]. We describe a patient in whom a relatively modest blood transfusion resulted in acute hyperkalaemia with a 'near-miss' cardiac arrest. Case historyA frail 74-year-old woman was scheduled for an exploratory laparotomy for a suspected uterine malignancy. She had a history of longstanding hypertension and hypothyroidism, but no history of ischaemic heart disease. She was a nonsmoker and had, until recently, a good exercise tolerance for her age. Medication on admission included amlodipine 5 mg daily and thyroxine 100 mg daily.On examination she was markedly cachectic, weighing only 42 kg, and had a hard mass protruding from her pelvis into her lower abdomen.Her pre-operative ECG was normal and laboratory investigations showed a haemoglobin of 12.7 g.dl À1 , a normal coagulation profile, potassium of 4.4 mmol.l À1 , albumin of 35 g.dl À1 and normal urea and creatinine levels.After application of routine monitoring, anaesthesia was induced with propofol (1.5 mg.kg À1 ) and fentanyl citrate (3 mg.kg À1 ). Cisatracurium besylate (0.20 mg.kg À1 ) was used to facilitate tracheal intubation and the patient's lungs were ventilated with a 50 : 50% mixture of oxygen, nitrous oxide and 1% isoflurane. A 14G peripheral intravenous, 20G radial arterial cannula and a triple-lumen internal jugular central venous pressure (CVP) line were positioned after the induction of anaesthesia.Laparotomy revealed a large, locally aggressive leiomyosarcoma arising from the uterus, and a radical hysterectomy and a debulking procedure was planned.Approximately 1 h after the start of surgery, during debulking of the tumour mass, a sudden blood loss of approximately 1500 ml caused a sudden decrease in the patient's blood pressure from 130/85 mmHg to 75/ 40 mmHg. This was associated with a tachycardia and rapid decrease in the CVP from 6 mmHg to 0 mmHg.Initial fluid resuscitation with 1000 ml 0.9% saline and 1000 ml Haemaccel® solution produced a temporary improvement in the patient's blood pressure. After further blood loss, a blood transfusion was started with two units (740 ml) of blood, which was transfused rapidly over 5-10 min via a fluid warming system. During the rapid infusion of blood, the ECG was noted to show an increase in the size of the T waves, followed rapidly by a widening of the QRS complexes. The pulse rate decreased from 80

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“…In case reports hyperkalemia-induced situations needing reanimation are described [41,42]. Retrospective evaluations of massively transfused collectives represent transient hyperkalemias, which regulate until the end of the period of transfusion [43][44][45]. Other investigators could not prove the expected increase of K + [46][47][48], and further study groups warn of a hypokalemia during massive transfusion [49][50].…”

Section: Hyperkalemiamentioning

confidence: 99%

Massive Transfusion and Its Influence on Oxygen Transport and Electrolyte Balance

Schmitt¹,

Lackes²

2000

Transfus Med Hemother

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During the process of storing erythrocyte-containing blood products, components of the preservatives and modifications of the erythrocyte function cause disorders of the electrolyte and acid-base balance as well as a deficiency of 2,3-diphosphoglycerate (2,3-DPG). Thereby transitory hyperkalemias may occur in the course of a massive transfusion, if the patient has a shock or another disturbance of the regulating mechanisms caused by diabetes mellitus or a treatment with β-blockers or ACE inhibitors. During the treatment with blood components, hypocalcemia and hypomagnesemia may develop after a dose of more than 12 fresh frozen plasms (FFP) per hour, if the metabolism of citrate, which binds bivalent cations as a chelate, is disturbed by hypothermia, shock or during the anhepatic stage of a liver transplantation. As a consequence, a low-output syndrome as well as tachyarrhythmias and torsades de pointes may develop. Whether the decrease of the 2,3-DPG level with the accompanying leftward shift of the oxyhemoglobin dissociation curve brings about a deficiency of the oxygen supply of the organs, has not yet been verified by experiment. The studies presented rather point at morphological changes of the erythrocytes due to the storage as the cause of the disturbances of capillary perfusion. For this reason patients with impending organ failure or marked disturbances of the coronary or cerebral perfusion should be transfused with packed red blood cells (RBCs) not older than 14 days.

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Hyperkalaemia during massive blood transfusion in paediatric craniofacial surgery

Cited by 59 publications

References 23 publications

Resuscitative Hyperkalemia in Noncrush Trauma

Resuscitative Hyperkalemia in Noncrush Trauma

‘Near‐miss’ hyperkalaemic cardiac arrest associated with rapid blood transfusion

Massive Transfusion and Its Influence on Oxygen Transport and Electrolyte Balance

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