title: Postoperative hyperkalemia.
abstract: Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided.
authors.affiliation: Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, USA.
authors.forename: Taha
authors.initials: T
authors.lastname: Ayach
authors.affiliation: University of Florida Shands Hospital, Gainesville, FL, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Nappo
authors.affiliation: Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Paugh-Miller
authors.affiliation: University of Central Florida, Orlando, FL, USA. Electronic address: Edward.ross@ucf.edu.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Ross
mesh_terms: D050110:Bariatric Surgery; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000378:metabolism; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology / Q000378:metabolism*; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects; D056888:Patient Positioning / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism*; D011188:Potassium / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000378:metabolism; D012206:Rhabdomyolysis / Q000209:etiology / Q000378:metabolism; D012307:Risk Factors; D013390:Succinylcholine / Q000009:adverse effects; D065227:Transfusion Reaction; D014656:Vascular Surgical Procedures
chemical_list: D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D011188:Potassium
keywords: Drug adverse effect; Hyperkalemia; Postoperative; Rhabdomyolysis; Transfusions