[A patient with severe hyperkalaemia -- an emergency after RALES].

Abstract

HISTORY AND ADMISSION FINDINGS:

A 59-year-old man was referred to the hospital for psychiatric reasons. To control hypertension and chronic heart failure he had been treated with 5 mg ramipril and 12.5 mg hydrochlorothiazide. In addition, he received 25 mg spironolactone. A prostate disease was diagnosed two months ago.

INVESTIGATIONS:

Laboratory analysis revealed a severe hyperkalemia (9.3 mmol/l) as well as an increase in creatinine (24.3 mg/dl) and urea nitrogen (349.0 mg/dl). The ECG showed a bradycardia with increased T-wave amplitudes. Abdominal sonography revealed a full urinary bladder.

TREATMENT AND COURSE:

Administration of terbutaline, sodium bicarbonate, and glucoseinfusion lowered potassium level to 6.3 mmol/l before hemodialysis was started. Hyperplasia of the prostate gland was found to be the reason for acute renal failure. Dialysis treatment was only temporarily necessary; afterwards, the patient was transferred to the urology department for subsequent therapy.

CONCLUSION:

Hyperkalemia is a life-threatening emergency that requires immediate therapy. Conservative treatment allows to partially correct water-electrolyte imbalance until hemodialysis can be performed. Hyperkalemia often results from the administration of combination therapy with ACE-inhibitors/AT (1)-antaganonists and antikaliuretic diuretics (spironolactone) in renal failure.

• Authors: J Nürnberger, A Daul, T Philipp
• Journal: Deutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 130 Issue 36 Pg. 2008-11 (Sep 09 2005) ISSN: 0012-0472 [Print] Germany
• Vernacular Title: Patient mit schwerer Hyperkaliämie -- ein Notfall nach RALES.
• PMID: 16143930 (Publication Type: English Abstract, Journal Article)

Chemical References

• Adrenergic beta-Agonists
• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Diuretics
• Hydrochlorothiazide
• Sodium Bicarbonate
• Glucose
• Ramipril
• Terbutaline

Topics

• Acute Kidney Injury (complications, drug therapy, etiology, therapy)
• Adrenergic beta-Agonists (therapeutic use)
• Angiotensin II Type 1 Receptor Blockers (adverse effects, therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (adverse effects, therapeutic use)
• Bradycardia (complications, diagnosis)
• Diuretics (adverse effects, therapeutic use)
• Drug Therapy, Combination
• Electrocardiography
• Emergencies
• Glucose (administration & dosage)
• Heart Failure (complications, drug therapy)
• Humans
• Hydrochlorothiazide (adverse effects, therapeutic use)
• Hyperkalemia (complications, drug therapy, etiology)
• Hypertension (complications, drug therapy)
• Male
• Mental Disorders (complications)
• Middle Aged
• Prostatic Hyperplasia (complications)
• Ramipril (adverse effects, therapeutic use)
• Renal Dialysis
• Sodium Bicarbonate (therapeutic use)
• Terbutaline (therapeutic use)