Acute hyponatremia after cardioplegia by histidine-tryptophane-ketoglutarate--a retrospective study.
BACKGROUND
Hyponatremia is the most common electrolyte disorder in hospitalized patients and is known to be associated with increased mortality. The administration of antegrade single-shot, up to two liters, histidine-tryptophane-ketoglutarate (HTK) solution for adequate electromechanical cardiac arrest and myocardial preservation during minimally invasive aortic valve replacement (MIAVR) is a standard procedure. We aimed to determine the impact of HTK infusion on electrolyte and acid-base balance.


METHODS
In this retrospective analysis we reviewed data on patient characteristics, type of surgery, arterial blood gas analysis during surgery and intra-/postoperative laboratory results of patients receiving surgery for MIAVR at a large tertiary care university hospital.


RESULTS
A total of 25 patients were included in the study. All patients were normonatremic at start of surgery. All patients developed hyponatremia after administration of HTK solution with a significant drop of serum sodium of 15 mmol/L (p < 0.01). Measured osmolality did not change during all times of surgery compared to start of surgery (p = 0.28 - p = 0.79), indicating isotonic hyponatremia. After administration of HTK solution pH fell significantly due to development of metabolic acidosis.


CONCLUSIONS
Acute hyponatremia during cardioplegia with HTK solution is isotonic and should probably not be corrected without presence of hypotonicity as confirmed by measurement of serum osmolality.
Department of Emergency Medicine, Inselspital University Hospital Bern, Bern, Switzerland. lindner.gregor@gmail.com
Gregor
G
Lindner
Bernhard
B
Zapletal
Christoph
C
Schwarz
Wilfried
W
Wisser
Michael
M
Hiesmayr
Andrea
A
Lassnigg
D000368:Aged; D002314:Cardioplegic Solutions / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005947:Glucose / Q000009:adverse effects / Q000627:therapeutic use; D006324:Heart Arrest, Induced / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced*; D008297:Male; D008353:Mannitol / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009994:Osmolar Concentration; D011189:Potassium Chloride / Q000009:adverse effects / Q000627:therapeutic use; D011343:Procaine / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies
C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose