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

Author(s): Nurnberger J, Daul A, Philipp T

Affiliation(s): Klinik fur Nieren- und Hochdruckkrankheiten, Universitatsklinikum Essen. jens.nuernberger@uni-essen.de

Publication date & source: 2005-09-09, Dtsch Med Wochenschr., 130(36):2008-11.

Publication type: English 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.