Electrocardiographic features of hyperkalemia during acute kidney injury in a patient with pacemaker

We describe a case of a 79-year-old man with pacemaker who presented to the Emergency Department due to asthenia and acute confusional state. He had a history of atrial fibrillation, anemia and colostomy and he was on treatment with diuretics. The electrocardiogram (ECG) showed pacemaker-induced ventricular activity, QRS complexes excessively wide with sine-wave appearance, tall and peaked T waves, without electrically evident atrial activity. Potassium concentration on arterial blood gas analysis was 8.8 mmol/L. ECG abnormalities disappeared after therapy with calcium chloride and spontaneous cardiac activity reappeared.

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Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man

Case Reports in Anesthesiology ◽

10.1155/2014/250502 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Michihiro Sakai ◽

Noriko Murakami ◽

Yuji Kitamura ◽

Shin Sato ◽

Hiroshi Iwama ◽

...

Keyword(s):

Malignant Hyperthermia ◽

Lung Ventilation ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

History Of ◽

End Tidal ◽

High Degree

Malignant hyperthermia (MH) is a rare but potentially fatal complication that may develop under general anesthesia (GA) and is rarely reported in elderly patients. We encountered a case of mild-onset MH in a 70-year-old patient who was receiving an elective thoracoscopic pulmorrhaphy and had a history of several GA procedures. Anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane and remifentanil. His body temperature (BT) was 37.9°C after induction. During the procedure, the end-tidal CO2(ETCO2) increased steadily to 47–50 mmHg, presumably in response to the single lung ventilation. At the end, BT was 38.1°C and ETCO2was 47 mmHg under spontaneous breathing. After extubation, the patient wheezed on inspiration and expiration, and his trachea was reintubated. Sixty minutes after surgery, BT increased to 40.5°C and the arterial blood gas analysis showed severe metabolic acidosis. Based on these findings, MH was suspected and a bolus dose of dantrolene was administered. He responded to the dantrolene, and no complications or recurrence of MH was observed postoperatively. In this patient, the initial signs of MH were so subtle that making the diagnosis of MH was difficult. A high degree of suspicion is necessary to prevent a fulminant MH crisis.

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Severe Hypertriglyceridaemia Leading to Factitious Hypobicarbonataemia

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_003046 ◽

2021 ◽

Author(s):

Sasmit Roy ◽

Mohammed Ashraf ◽

Satbyul Sophia Kang ◽

Raul Ayala ◽

Sreedhar Adapa

Keyword(s):

Laboratory Finding ◽

Kidney Injury ◽

Blood Gas Analysis ◽

Blood Chemistry ◽

Gas Analysis ◽

Arterial Blood Gas ◽

Large Molecules ◽

Arterial Blood ◽

Lipid Panel ◽

Arterial Blood Gas Analysis

Anion gap metabolic acidosis is a laboratory finding commonly encountered in patients with sepsis, diabetic ketoacidosis, acute kidney injury and toxic alcohol ingestion. Serum blood chemistry assessment detects this abnormality. However, this can be falsely low in situations of high triglyceride levels due to lipid interference with measurement of the bicarbonate levels and through volume displacement by these large molecules. Arterial blood gas analysis and a lipid panel are required to confirm accurate bicarbonate levels. Clinicians handling acid-base disorders in hospitalized patients need to be aware of this spurious laboratory value to avoid unnecessary tests and to determine accurate total bicarbonate levels.

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