Korean J Transplant.  2022 Nov;36(Supple 1):S179. 10.4285/ATW2022.F-3049.

Accidental intra-operative hyperkalemia in living donor liver transplantation

• Lundeg G
• Kh B
• R B
• B D
• P E
• D C
• D EA

• KMID: 2535695
• DOI: http://doi.org/10.4285/ATW2022.F-3049

Abstract

Given the potential lethal effects on the myocardium including dysrhythmias, hyperkalemia (serum potassium 5.5 mmol/L) is considered a medical emergency that warrants prompt evaluation and treatment. A 46-year-old male who underwent liver transplantation suffered of alcoholic liver cirrhosis and hepatitis B. Preoperatively the patients body weight was 77 kg, height 170 cm, had mild dyspnea and edema, moderate ascites, model for end-stage liver disease 11 and vital signs were stable. In preoperative laboratory results; the potassium 4.92 mmol/L, creatinine 3.21 mg/dL, bilirubin 2.5 mg/dL, and urea 93.4 mg/ dL. In the preoperative settings, infusion of potassium chloride 7.5% (100 mL) in 5% (500 mL) glucose for three times within 2days, presumably, was one of the reasons for intra-operative hyperkalemia. Anesthesia was induced at 05:30 AM on May 6, 2022, with propofol (120 mg), fentanyl (50 g), with rocuronium (40 mg), further maintained by sevoflurane (titrated to maintain the bispectral index at 50–60), fentanyl (0.1–0.5 g/kg/hr) and rocuronium infusion by pump syringe. Around in 3 hours from the beginning of general anesthesia the potassium level increased dramatically. The table 1 shows the level of potassium and AGB intra-operatively. The therapy for hyperkalemia urgently started when the laboratory results confirmed of the serum level of potassium measured as 7.2 mmol/Lat 08:30 and the highest level reached at 9:23 AM. As potassium lowering therapy, we administered 10 mL of 10% calcium gluconate was given IV at 100 mL saline repeatedly for five times, and 20 IU of short-acting insulin at 20 % (200 mL) glucose two times and sodium bicarbonate 4% as 100 mL two times. We continued potassium-lower-ing therapy until the serum potassium reached the level of 4.8 mmol/L at 16:17 PM. Upon completion of LDLT surgery his serum potassium was normal (4.2 mmol/L) and the next day it lowered down to 3.54 mmol/L.