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


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Nürnberger
J
J
Klinik für Nieren- und Hochdruckkrankheiten, Universitätsklinikum Essen. jens.nuernberger@uni-essen.de
Daul
A
A
Philipp
T
T
D058186:Acute Kidney Injury / Q000150:complications* / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects* / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004630:Emergencies; D005947:Glucose / Q000008:administration & dosage; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use; D006947:Hyperkalemia / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000150:complications; D017257:Ramipril / Q000009:adverse effects / Q000627:therapeutic use; D006435:Renal Dialysis; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013726:Terbutaline / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D006852:Hydrochlorothiazide; D017693:Sodium Bicarbonate; D005947:Glucose; D017257:Ramipril; D013726:Terbutaline