Potassium Level Variation Following Packed Cell Transfusion in Critically Ill Adult Patients—How Alert Should We Be?

Frenkel, Amit; Hassan, Lior; Glick, Aviad; Pikovsky, Oleg; Boyko, Matthew; Binyamin, Yair; Novack, Victor; Klein, Moti

doi:10.3390/jcm11113117

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…Patients with serum potassium levels greater than 5 mEq/L were excluded from the analysis, as high potassium levels may prompt staff to administer PCT at a slower rate, to avoid life-threatening hyperkalemia (15). Notably, slow administration of the infusion may cause a different amplitude in core temperature.…”

Section: Methodsmentioning

confidence: 99%

Body temperature variation following packed cell transfusion in adult patients with sepsis – Where will the pendulum stop?

Klein¹,

Hassan

Binyamin

et al. 2023

Shock

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Background: Critically ill patients with sepsis often require packed cell transfusions (PCTs). Packed cell transfusion causes changes in body's core temperature. Objective: To trace the course and amplitude of body core temperature after PCT in adults with sepsis. Methods: We conducted a population-based retrospective cohort study of patients with sepsis who received one unit of PCT during their hospitalization in a general intensive care unit during 2000-2019. A control group was established by matching each of these patients to a patient who did not receive PCT. We calculated the mean values of urinary bladder temperature for the 24 h before and 24 h after PCT. To evaluate the effect of PCT on body core temperature, multivariable analyses using a mixed linear regression model were performed. Results: The study comprised 1,100 patients who received one unit of PCT and 1,100 matched patients. The mean temperature before PCT was 37.3°C. Immediately from initiation of PCT, body temperature decreased, to a minimum of 37.0°C. During the 24 subsequent hours, the temperature increased gradually and consistently, until a peak temperature of 37.4°C. In a linear regression model, body core temperature increased by a mean 0.06°C in the first 24 h after PCT and decreased by a mean 0.65°C for every 1.0°C increase before PCT. Conclusions: Among critically ill patients with sepsis, PCT itself causes only mild and clinically insignificant temperature changes. Thus, significant changes in core temperature during the 24 h after PCT may indicate an unusual clinical event that requires clinicians' immediate attention.

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Section: Methodsmentioning

confidence: 99%

Body temperature variation following packed cell transfusion in adult patients with sepsis – Where will the pendulum stop?

Klein¹,

Hassan

Binyamin

et al. 2023

Shock

Self Cite

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“…Importantly, in daily clinical practice, plasma electrolytes are measured by serial analysis (e.g., every 1 or 2 h for patients with hypernatremia or every 6 h for hypocalcemia, but shorter frequencies have been reported) of collected and pretreated blood . The new MIMN patch could replace these recurrent measurements through a less invasive and faster approach and provide more strict monitoring of specific clinical treatments and procedures, such as packed cell transfusion …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…6 The new MIMN patch could replace these recurrent measurements through a less invasive and faster approach and provide more strict monitoring of specific clinical treatments and procedures, such as packed cell transfusion. 20 Ex Vivo Analytical Characterization of the MIMN Patch. Before in vivo transdermal measurements, the resiliency of the MIMN patch to skin penetration was evaluated to confirm the absence of any alteration in the electrodes' responses that might cause inaccurate results.…”

Section: ■ Experimental Sectionmentioning

confidence: 99%

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In Vivo Transdermal Multi-Ion Monitoring with a Potentiometric Microneedle-Based Sensor Patch

et al. 2022

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Microneedle sensor technology offers exciting opportunities for decentralized clinical analyses. A novel issue puts forward herein is to demonstrate the uniqueness of membrane-based microneedles to accomplish real-time, on-body monitoring of multiple ions simultaneously. The use of multi-ion detection is clinically relevant since it is expected to provide a more complete and reliable assessment of the clinical status of a subject concerning electrolyte disorders and others. We present a microneedle system for transdermal multiplexed tracing of pH, Na + , K + , Ca 2+ , Li + , and Cl − . The device consists of an array of seven solid microneedles externally modified to provide six indicator electrodes, each selective for a different ion, and a common reference electrode, all integrated into a wearable patch read in a potentiometric mode. We show in vitro measurements at the expected clinical levels, resulting in a fast response time, excellent reversibility and repeatability, and adequate selectivity. Closeto-Nernstian sensitivity, sufficient stability and resiliency to skin penetration guarantee the sensor's success in transdermal measurements, which we demonstrate through ex vivo (with pieces of rat skin) and in vivo (on-body measurements in rats) tests. Accuracy is evaluated by comparison with gold standard techniques to characterize collected dermal fluid, blood, and serum. In the past, interstitial fluid (ISF) analysis has been challenging due to difficult sample collection and analysis. For ions, this has resulted in extrapolations from blood concentrations (invasive tests) rather than pure measurements in ISF. The developed microneedle patch is a relevant analytical tool to address this information gap.

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“…With their smaller circulating volumes, paediatric patients are at particular risk of transfusion-related hyperkalemic cardiac arrest (TRHCA) [17 ▪ ], with increased age of pRBCs and concomitant acidosis or hypocalcaemia compounding the risk [52]. A single unit of pRBCs has been shown to raise [K] by 0.09 mmol/l among critically ill adults [53 ▪ ]. As little as 1 unit of can precipitate TRHCA in neonates and 4 units in adults [54], when conditions that increase the myocardial sensitivity to potassium such as hypocalcaemia, acidosis and hypothermia are present.…”

Section: Hyperkalaemiamentioning

confidence: 99%

Biochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility

Milne¹,

Radhakrishnan²

2022

Current Opinion in Anaesthesiology

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Purpose of reviewWith advances in resuscitative techniques, trauma patients are surviving increasingly severe injuries and physiological insult. Timely recognition of futility remains important in terms of patient dignity and resource preservation yet is increasingly challenging in the face of these advances. The understanding of biochemical derangement from pathophysiological processes of trauma and iatrogenic effects of resuscitation has expanded recently.Recent findingsAcidosis and hypocalcaemia have been recognized as important contributors to mortality among trauma patients. Although less well recognized and studied, critical injury and high blood product volume resuscitation render patients vulnerable to life-threatening hyperkalaemia. The methods of correcting disruptions to acid–base and electrolyte homeostasis during damage control resuscitation have changed little recently and often rely on evidence from undifferentiated populations. Biochemical disturbances have value as ancillary predictors of futility in trauma resuscitation.SummaryThese findings will contribute to a greater understanding among anaesthesiologists of the causative mechanisms and effects of biochemical derangement after severe injury and aid them in the delivery of well tolerated and effective damage control resuscitation. Gaps in the evidence base are highlighted to encourage future work.

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Potassium Level Variation Following Packed Cell Transfusion in Critically Ill Adult Patients—How Alert Should We Be?

Cited by 4 publications

References 16 publications

Body temperature variation following packed cell transfusion in adult patients with sepsis – Where will the pendulum stop?

Body temperature variation following packed cell transfusion in adult patients with sepsis – Where will the pendulum stop?

In Vivo Transdermal Multi-Ion Monitoring with a Potentiometric Microneedle-Based Sensor Patch

Biochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility

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