Acute Crit Care.  2018 Nov;33(4):271-275. 10.4266/acc.2016.00696.

Sudden Intraoperative Hyperkalemia during Laparoscopic Radical Nephrectomy in a Patient with Underlying Renal Insufficiency

• Jung SH
• Han YJ
• Shin SH
• Lee HS
• Lee JY

• KMID: 2441246
• DOI: http://doi.org/10.4266/acc.2016.00696

Abstract

We experienced a case of severe intraoperative hyperkalemia during laparoscopic radical nephrectomy in a 60-year-old male patient with renal insufficiency, whose hypertension had been managed by preoperative angiotensin II receptor blocker (ARB) and adrenergic beta-antagonist. 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.

Keyword

adrenergic beta-antagonist; angiotensin II receptor blocker; hyperkalemia; renal insufficiency; rhabdomyolysis

MeSH Terms

Calcium Gluconate
Electrocardiography
Furosemide
Humans
Hyperkalemia*
Hypertension
Insulin
Ligation
Male
Middle Aged
Nephrectomy*
Postoperative Period
Potassium
Receptors, Angiotensin
Renal Insufficiency*
Rhabdomyolysis
Calcium Gluconate
Furosemide
Insulin
Potassium
Receptors, Angiotensin

Figure

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  Figure 1. Abdominal and pelvic spiral computed tomography shows an approximately 6.3-cm-sized probable enhancing solid lesion in the lower pole of the left kidney and multiple variable-sized cysts in both kidneys.

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