Intraoperative Hyperkalemia: Death in Renal Parathyroidectomy

Abstract

Objective: Recognize potential life-threatening complications of intraoperative hyperkalemia during parathyroid surgery to control secondary hyperparathyroidism in renal patients. We present a case of a 20-year-old renal patient who died from VF arrest intraoperatively during elective surgery for secondary hyperparathyroidism. Understand the importance of intraoperative potassium monitoring. Method: Prospective analysis of intraoperative monitoring of potassium levels in patients with CRF undergoing total parathyroidectomy from April 2006 to July 2009 at Hull Royal Infirmary (UK). All patients had postdialysis preoperative potassium levels checked, at least 2 intraoperative levels, and 1 postoperative level. Results: Twenty-nine patients underwent total parathyroidectomy. A total of 17 out of 29 had intraoperative potassium rises, 55% (95% CI 38-71%) had intraoperative potassium rise above the normal limit (5.3 mM). Six patients (21% (95% CI 10-38%)) required intraoperative treatment with dextrose-insulin infusion. Active intervention was taken for patients who had rises greater than 0.5 mM or active ECG changes. Four patients had increasing potassium levels despite treatment indicating that without treatment these could potentially have been very high. Comparative results of postinduction and first intraoperative potassium levels were a good indicator of potassium rise later and the need for treatment ( P = .003). Conclusion: Hyperkalemia is a recognized complication within the first 24 hours postparathyroidectomy; however, it can occur more commonly intraoperatively in renal patients with potential devastating effects. Our unfortunate mortality complication has led us to change practice and we advocate active intraoperative monitoring and treatment to prevent such complications.