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

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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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