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Case Report
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
Acute Crit Care. 2017;33(4):271-275.   Published online November 21, 2018
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AbstractAbstract PDF
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.


Citations to this article as recorded by  
  • Acute Intraoperative Hyperkalemia During Robot-Assisted Radical Cystectomy: A Case Report
    Nivedhyaa Srinivasaraghavan, Vallary Modh, Arun Menon
    A&A Practice.2022; 16(12): e01650.     CrossRef

ACC : Acute and Critical Care