Life-threatening hyperkalaemia following therapeutic barbiturate coma.
OBJECTIVE
To report the occurrence of life-threatening hyperkalaemia following treatment with therapeutic thiopentone coma.


METHODS
The neurosurgical intensive care units of Royal North Shore Hospital and Liverpool Hospital, Sydney, Australia.


METHODS
Three patients treated with theraputic thiopentone coma. One patient with raised intracranial pressure secondary to a severe traumatic brain injury and two patients with refractory vasospasm secondary to subarachnoid haemorrhage. Two of the three patients developed hypokalaemia on starting thiopentone, which was resistant to potassium supplementation. All three patients developed severe hyperkalaemia during the recovery phase of coma. This was life-threatening in all three patients and fatal in one.


CONCLUSIONS
Severe hypokalaemia refractory to potassium therapy may occur during therapeutic thiopentone coma. Severe rebound hyperkalaemia may occur after cessation of thiopentone infusion. Protocols for the management of patients with therapeutic barbiturate coma should recognise this potentially serious complication.
Cairns
Christopher J S
CJ
Intensive Care Unit, Royal North Shore Hospital, St. Leonards, Sydney NSW, 2065, Australia.
Thomas
Benjamin
B
Fletcher
Stephen
S
Parr
Michael J A
MJ
Finfer
Simon R
SR
D000328:Adult; D001315:Australia; D001930:Brain Injuries / Q000628:therapy; D003128:Coma / Q000139:chemically induced*; D016638:Critical Illness; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000473:pathology; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000628:therapy; D013874:Thiopental / Q000009:adverse effects*; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D013874:Thiopental