Excessive hypokalemia and hyperkalemia following head injury.
A sudden decrease of serum potassium below 2.5 mmol/l carries the risk of dangerous arrhythmias and requires immediate replacement therapy [6]. We refer to a patient with a brain stem compression after head injury, who developed a profound hypokalemia (K+ = 1.2 mmol/l) with life-threatening arrhythmias, probably due to a catecholamine induced intracellular potassium shift (beta-2-stimulation). Only by aggressive potassium replacement up to 80 mmol/h (610 mmol/16 h) could potassium levels be increased and cardiac arrhythmias terminated. Although replacement therapy was stopped when the serum K(+)-level increased to 2.4 mmol/l, 3.5 h later the patient became hyperkalemic (8.1 mmol/l). This was probably due to a secondary shift of potassium from intra- to extracellular space. In patients with severe head trauma and the potential risk of excessive catecholamine release special attention must be paid to changes in potassium balance.
Schaefer
M
M
Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Benjamin Franklin, Berlin, Germany.
Link
J
J
Hannemann
L
L
Rudolph
K H
KH
D006259:Craniocerebral Trauma / Q000150:complications*; D006408:Hematoma, Subdural / Q000601:surgery; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology*; D007008:Hypokalemia / Q000188:drug therapy / Q000209:etiology*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011188:Potassium / Q000627:therapeutic use
D011188:Potassium