Hyperkalemia following massive transfusion in trauma.
BACKGROUND
Large-volume blood transfusions have been implicated in the development of hyperkalemia. The purpose of the current study was to determine whether critically injured patients receiving massive transfusions are at an increased risk of hyperkalemia.


METHODS
Massive transfusion (MT) cohort, all trauma patients (02/2004-01/2008) taken directly to the OR and receiving >or=10 units of RBC in first 24h. Comparison cohort (No-RBC), all patients (02/2004-01/2008) transported directly to the OR who received no blood products in the first 24h. Hyperkalemia defined as K+ > 5.5 mEq/L.


RESULTS
There were 266 MT patients, 237 No-RBC patients. MT patients were more likely to have hyperkalemia in the immediate postoperative setting (1.8% versus 4.6%, P = 0.049). However, linear regression did not identify intraoperative blood transfusions as a predictor of postoperative K+ values (P = 0.417). Logistic regression identified only preop K+ (OR 1.79, P = 0.021) and postop pH (OR 0.009, P = 0.001), but not MT, as independent risk factors for postop hyperkalemia.


CONCLUSIONS
Despite concerns of hyperkalemia following MT, we found less than a 5% incidence of postop K+ (>5.5 mEq/L). After adjusting for the significant effects of preop K+ and postop pH, MT patients were at no higher risk of hyperkalemia than those who received no blood products.
Au
Brigham K
BK
Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Dutton
William D
WD
Zaydfudim
Victor
V
Nunez
Timothy C
TC
Young
Pampee P
PP
Cotton
Bryan A
BA
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000453:epidemiology*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011188:Potassium / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000628:therapy*
D011188:Potassium