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The Journal of Cardiovascular Surgery 1998 Ottobre;39(5):651-4

lingua: Inglese

Life-threat­en­ing reper­fu­sion inju­ry in skel­e­tal mus­cle: a sim­ple tech­nique to con­trol crit­i­cal hyper­ka­le­mia

Utoh J., Goto H., Hir­a­ta T., Hara M., Moriy­a­ma Sh., Ide­ta I., Kitamura N.

From ­the First Department of Surgery Kumamoto University School of Medicine Kumamoto City, Kumamoto, Japan


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A 55-­year-­old ­male suf­fer­ing ­from ­acute abdom­i­nal aor­tic occlu­sion ­due to iat­ro­gen­ic aor­tic dis­sec­tion ­was urgent­ly admit­ted to hos­pi­tal. An axil­lo-bife­mo­ral ­bypass ­was con­struct­ed 6 ­hours ­from ­the ­onset of dis­sec­tion. Before ­and ­after revas­cu­lar­iza­tion, ­blood sam­ples ­were repeat­ed­ly ­obtained ­from a system­ic ­artery ­and femo­ral ­vein. The arte­ri­al potas­sium con­cen­tra­tion grad­u­al­ly ­increased, reach­ing 7.3 mM/L. Oliguria ­and arrhyth­mi­as ­occurred, ­and ­the ­left low­er ­limb ­became rig­id 3 ­hours ­after reper­fu­sion. The femo­ral ­artery ­and ­vein ­were clam­ped ­and with­in 30 min­utes, ­the arte­ri­al potas­sium con­cen­tra­tion ­fell to 4.8 mM/L. The ­urine out­put ­increased. The ­left low­er ­limb ­was ampu­tat­ed, ­and ­the ­patient sur­vived. Immediately fol­low­ing revas­cu­lar­iza­tion, hyper­ka­le­mia ­may ­occur. Clamping of ­the affer­ent ­and effer­ent ves­sels is rec­om­mend­ed as a sim­ple ­and prac­ti­cal tech­nique to quick­ly con­trol ­life-threat­en­ing hyper­ka­le­mia.

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