Hypokalaemia with severe rebound hyperkalaemia after therapeutic barbiturate coma.
Severe disturbance of potassium balance is a rare but life-threatening complication of therapeutic barbiturate coma. A 14-yr-old patient was treated with a thiopental infusion for management of increased intracranial pressure after severe head injury. The patient had persistent hypokalaemia during the thiopental infusion. On cessation of the infusion the patient rapidly developed a tachydysrhythmia associated with a serum K+ of 7.0. Possible mechanisms of this phenomenon are discussed. We conclude that aggressive treatment of hypokalaemia during barbiturate coma should be avoided, and advocate a tapering dose of thiopental and not abrupt cessation of an infusion. Severe disturbance of plasma potassium balance is a rare but life-threatening complication of therapeutic barbiturate coma. Awareness of this complication should be raised and management altered to less aggressive treatment of hypokalaemia occurring during thiopental infusion, with a tapering dose used on discontinuation to limit a rebound phenomenon.
Neil
Michael J E
MJ
Department of Anaesthesia and Critical Care, Ninewells Hospital, Dundee, Scotland, DD2 9SY. mneil@nhs.net
Dale
Megan C
MC
D000063:Accidents, Traffic; D000293:Adolescent; D001926:Brain Death; D001930:Brain Injuries / Q000097:blood / Q000628:therapy*; D003128:Coma / Q000097:blood* / Q000139:chemically induced; D003422:Critical Care; D017809:Fatal Outcome; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007008:Hypokalemia / Q000139:chemically induced*; D007427:Intracranial Pressure / Q000187:drug effects; D013874:Thiopental / Q000009:adverse effects*
D006993:Hypnotics and Sedatives; D013874:Thiopental