Severe hypokalemia and rebound hyperkalemia during barbiturate coma in patients with severe traumatic brain injury.

Abstract

OBJECTIVES:

To evaluate the incidence of severe potassium disturbances during barbiturate coma therapy in patients with severe traumatic brain injury (TBI), and the characteristics of these patients.

METHODS:

The study comprised 37 patients with severe TBI who were treated for barbiturate coma between 2015 and 2017 in level 3 intensive care units of two hospitals.

RESULTS:

No potassium disturbance occurred in 14 patients. Seventeen patients developed mild-moderate hypokalemia (2.6-3.5mEq/L), and 6 patients developed severe hypokalemia (<2.5mEq/L) following the induction of barbiturate therapy. The incidence of mild-to-severe barbiturate-induced hypokalemia was 62.2% and the rate of severe hypokalemia was 16.2%. The mean potassium supply per day during thiopentone therapy was statistically significantly different between patients with mild-to-moderate hypokalemic and those with severe hypokalemic (p<0.001). Four of 6 patients with severe hypokalemia developed rebound hyperkalemia exceeding 6mEq/L following the cessation of barbiturate infusion. The nadir potassium concentration was 1.5mEq/L and the highest value was 6.8mEq/L. The mean time to reach nadir potassium concentrations was 2.8 days. The mortality rate of the 6 patients was 66.7%. Of the 2 survivors of severe hypokalemia, the Glasgow Outcome Scale (GOS) on discharge and the extended GOS one year after the trauma were 5 and 8 respectively.

CONCLUSIONS:

Severe hypokalemia refractory to medical treatment and rebound hyperkalemia is a serious adverse effect of thiopentone coma therapy in patients with severe TBI. Excessive and aggressive potassium replacement during the barbiturate-induced hypokalemia period must be avoided. Weaning barbiturate treatment over time may be advantageous in the management of severe serum potassium disturbances.

• Authors: Hande Gurbuz Aytuluk, Hulya Topcu
• Journal: Neurocirugia (English Edition) (Neurocirugia (Astur : Engl Ed)) 2020 Sep - Oct Vol. 31 Issue 5 Pg. 216-222 ISSN: 2529-8496 [Electronic] Spain
• PMID: 32146086 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

Chemical References

• Barbiturates

Topics

• Barbiturates (adverse effects)
• Brain Injuries, Traumatic (complications, drug therapy)
• Coma (chemically induced)
• Humans
• Hyperkalemia (chemically induced, epidemiology)
• Hypokalemia (chemically induced)