Sudden intraoperative hyperkalemia during laparoscopic radical nephrectomy in a patient with underlying renal insufficiency

Sung Hoon Jung, Yun Joung Han, Sang Ho Shin, Hyo Seon Lee, Ji Young Lee

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

We experienced a case of severe intraoperative hyperkalemia during laparoscopic radical nephrectomy in a 60yearold male patient with renal insufficiency, whose hypertension had been managed by preoperative angiotensin II receptor blocker (ARB) and adrenergic betaantagonist. After renal vessel ligation, his intraoperative potassium concentration suddenly increased to 7.0 mEq/L, but his electrocardiography (ECG) did not show any significant change. While preoperative ARB therapy has been regarded as a contributing factor for further aggravation of underlying renal insufficiency, we assumed that nephrectomy itself and rhabdomyolysis caused by surgical trauma also aggravated the underlying renal dysfunction and resulted in sudden hyperkalemia. Hyperkalemia was managed successfully with calcium gluconate, insulin, furosemide and crystalloid loading during the intraoperative and immediate postoperative periods, and potassium concentration decreased to 5.0 mEq/L at 8 hours after the operation. The patient’s hospital course was uncomplicated, but his renal function deteriorated further.

Original languageEnglish
Pages (from-to)271-275
Number of pages5
JournalAcute and Critical Care
Volume33
Issue number4
DOIs
StatePublished - 2018

Bibliographical note

Publisher Copyright:
Copyright © 2018 The Korean Society of Critical Care Medicine.

Keywords

  • Adrenergic betaantagonist
  • Angiotensin II receptor blocker
  • Hyperkalemia
  • Renal insufficiency
  • Rhabdomyolysis

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