Postoperative hyperkalemia

Abstract

Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided.

Induction of Pluripotent Stem Cell-Derived Cardiomyocyte Toxicity by Supernatant of Long Term-Stored Red Blood Cells in Vitro

“…Clinical hyperkalemia resulting from RBCs transfusions has been recognized as a transfusion complication for decades. Hyperkalemia can not only lead to cardiac arrests [29], but it also occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines [30]. Clinically significant hyperkalemia can result following the infusion of a number of RBCs units, especially in infants and small children.…”

Coconut water drink and the risk of hyperkalaemia in diabetes

“…Detailed examination of case records revealed no particular cause for the progressive rise in potassium concentration. The possibility of intake of LoSalt salt substitutes was excluded . However, the patient admitted to regularly drinking CW since February and that in the past two months he had increased the daily consumption to around a litre of Vita Coco CW as a substitute for table water and carbonated soft drinks.…”

“…Reduction in eGFR is noticeable and raises concerns about the daily quantity of CW that can be safely consumed by people with diabetes or when on potassium‐retaining medication. Daily use of LoSalt can provide around 35mmol of potassium; its use in diabetes is clinically detrimental . In comparison, potassium load from CW (<50mmol daily in the present case) is likely to be equally harmful in patients with reduced renal excretion and in those with prescription drugs affecting the renin‐aldosterone system.…”

Rebound hyperkalemia after cessation of ritodrine in a parturient undergoing cesarean section

“…As suxamethonium was used to facilitate tracheal intubation in the present case, it might reinforce ritodrine-induced rebound hyperkalemia. Although plasma potassium levels may increase up to 1.0 mmol/L within 2–5 min following intravenous suxamethonium and the level quickly returns to a baseline value in healthy persons [ 9 ], hyperkalemia was detected even 1 h after iv suxamethonium. Therefore, iv suxamethonium may not be the main cause of hyperkalemia in the present case.…”

“…The following causes of perioperative hyperkalemia should also be considered: rhabdomyolysis from malpositioning, tissue ischemia, metabolic and respiratory acidosis, and blood transfusion [ 9 ]. In the present case, as positioning was carefully done to avoid peripheral nerve injury, rhabdomyolysis could be excluded from the cause.…”