Hyperkalaemia during general anaesthesia: six cases

Abstract

The objective of this case series is to describe the clinical course, treatment and outcome in six dogs following acute hyperkalaemia during general anaesthesia. A total of six dogs were presented for routine surgical and/or imaging procedures requiring general anaesthesia. All patients developed hyperkalaemia (ranging from 7.0 to 8.7 mmol/L, reference interval: 3.4–4.9 mmol/L), and electrocardiographic changes were seen in all but one case. The prognosis for treatment of hyperkalaemia during general anaesthesia appears to be excellent as all dogs fully recovered following treatment. To the authors’ knowledge, this is the first reported case series of hyperkalaemia during general anaesthesia in dogs. Our objective is to provide further information regarding possible causes for the development of hyperkalaemia in dogs under general anaesthesia.

Unanticipated hyperkalaemia and associated perioperative complications in three captive grey wolves (Canis lupus) undergoing general anaesthesia

“…A single bolus of medetomidine has been shown to suppress the sympathetic outflow of catecholamines for 180 min in dogs 62,64 . As previously discussed by other authors, the low circulating catecholamine levels might produce an imbalance in α‐ and β‐adrenoceptor activation, which over time may lead to a pronounced α‐adrenoreceptor stimulation, which in turn pushes potassium out of the cells 10 . These processes, in combination or alone, have been suspected of causing hyperkalaemia in anaesthetised felids, 11–15,17 dogs 8,10 and in a calf 18 .…”

“…The scientific evidence suggests that the long duration of anaesthesia 5–7,9,12,17 and use of medetomidine 8,10,12–14,17,18 were potential influencing factors. The process may have been aggravated or triggered by acidaemia, 7 cell lysis, 10,14 stress 7,8 or other unaddressed causes. Further research is warranted to elucidate the aetiology of hyperkalaemia during general anaesthesia in animals and to establish a solid relationship between hyperkalaemia and the use of α 2 ‐adrenoceptor agonists in wolves.…”

“…62,64 As previously discussed by other authors, the low circulating catecholamine levels might produce an imbalance in αand β-adrenoceptor activation, which over time may lead to a pronounced α-adrenoreceptor stimulation, which in turn pushes potassium out of the cells. 10 These processes, in combination or alone, have been suspected of causing hyperkalaemia in anaesthetised felids, [11][12][13][14][15]17 dogs 8,10 and in a calf. 18 In other case reports, describing an aggressive dog and a captive Persian leopard, the adrenoceptor imbalance was considered to be exacerbated or directly triggered by exaggerated stress with depletion of endogenous catecholamines.…”

“…Recently, unexpected perioperative hyperkalaemia has been reported in dogs not presenting signs of hyperkalaemia prior to anaesthesia, 5–10 and its prevalence is suspected to be higher than that reported in this species 7 . It has also been documented in numerous non‐domestic felids, 11–15 domestic cats 16,17 and in a calf 18 …”

“…strenuous exercise and toxins and has also been associated with the use of drugs in small animals and people. 1,4 Recently, unexpected perioperative hyperkalaemia has been reported in dogs not presenting signs of hyperkalaemia prior to anaesthesia, [5][6][7][8][9][10] and its prevalence is suspected to be higher than that reported in this species. 7 It has also been documented in numerous non-domestic felids, [11][12][13][14][15] domestic cats 16,17 and in a calf.…”