Postoperative hyperkalemia

    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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