Title

Postoperative hyperkalemia

Authors

Authors

T. Ayach; R. W. Nappo; J. L. Paugh-Miller;E. A. Ross

Comments

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Abbreviated Journal Title

Eur. J. Intern. Med.

Keywords

Hyperkalemia; Postoperative; Rhabdomyolysis; Transfusions; Drug adverse; effect; ADRENERGIC MODULATION; HOSPITALIZED-PATIENTS; POTASSIUM METABOLISM; RENAL-FAILURE; RHABDOMYOLYSIS; THERAPY; SURGERY; REPLACEMENT; INFUSION; RISK; Medicine, General & Internal

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. (C) 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Journal Title

European Journal of Internal Medicine

Volume

26

Issue/Number

2

Publication Date

1-1-2015

Document Type

Review

Language

English

First Page

106

Last Page

111

WOS Identifier

WOS:000350826300006

ISSN

0953-6205

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