Acute hyponatremia after cardioplegia by histidine-tryptophane-ketoglutarate--a retrospective study.

Abstract

BACKGROUND:

Hyponatremia is the most common electrolyte disorder in hospitalized patients and is known to be associated with increased mortality. The administration of antegrade single-shot, up to two liters, histidine-tryptophane-ketoglutarate (HTK) solution for adequate electromechanical cardiac arrest and myocardial preservation during minimally invasive aortic valve replacement (MIAVR) is a standard procedure. We aimed to determine the impact of HTK infusion on electrolyte and acid-base balance.

METHODS:

In this retrospective analysis we reviewed data on patient characteristics, type of surgery, arterial blood gas analysis during surgery and intra-/postoperative laboratory results of patients receiving surgery for MIAVR at a large tertiary care university hospital.

RESULTS:

A total of 25 patients were included in the study. All patients were normonatremic at start of surgery. All patients developed hyponatremia after administration of HTK solution with a significant drop of serum sodium of 15 mmol/L (p < 0.01). Measured osmolality did not change during all times of surgery compared to start of surgery (p = 0.28 - p = 0.79), indicating isotonic hyponatremia. After administration of HTK solution pH fell significantly due to development of metabolic acidosis.

CONCLUSIONS:

Acute hyponatremia during cardioplegia with HTK solution is isotonic and should probably not be corrected without presence of hypotonicity as confirmed by measurement of serum osmolality.

• Authors: Gregor Lindner, Bernhard Zapletal, Christoph Schwarz, Wilfried Wisser, Michael Hiesmayr, Andrea Lassnigg
• Journal: Journal of cardiothoracic surgery (J Cardiothorac Surg) Vol. 7 Pg. 52 (Jun 10 2012) ISSN: 1749-8090 [Electronic] England
• PMID: 22681759 (Publication Type: Journal Article)

Chemical References

• Bretschneider cardioplegic solution
• Cardioplegic Solutions
• Mannitol
• Procaine
• Potassium Chloride
• Glucose

Topics

• Aged
• Cardioplegic Solutions (adverse effects, therapeutic use)
• Female
• Glucose (adverse effects, therapeutic use)
• Heart Arrest, Induced (methods)
• Heart Valve Prosthesis Implantation
• Humans
• Hyponatremia (chemically induced)
• Male
• Mannitol (adverse effects, therapeutic use)
• Middle Aged
• Osmolar Concentration
• Potassium Chloride (adverse effects, therapeutic use)
• Procaine (adverse effects, therapeutic use)
• Retrospective Studies