Hyperkalaemia during two consecutive anaesthetics in an aggressive Bengal cat

Abstract

The development of unanticipated hyperkalaemia during general anaesthesia in healthy veterinary patients is an increasingly recognized phenomenon. Cases have been reported in dogs, cats, horses and non‐domestic felids. However, recurrent hyperkalaemia has not yet been described in domestic cats. We report the development of hyperkalaemia during two consecutive anaesthetics in a 5‐year‐old, Bengal cat, anaesthetised for medial patella luxation repair and 3 months later for implant removal. During both procedures, hyperkalaemia was diagnosed. However, it was only during the first anaesthetic that the hyperkalaemia became life‐threatening, necessitating treatment. The reasons why some animals develop hyperkalaemia during general anaesthesia are still unknown. Considering the apparent increasing frequency of this condition, hyperkalaemia should be considered as a potential cause of intraoperative bradydysrhythmias and must be investigated and treated appropriately.

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

“…The effectiveness of diverse combinations of sedatives and anaesthetics, including α 2 ‐adrenoceptor agonists, is well documented and considered safe for wolf immobilisation 58–61 . Interestingly, α 2 ‐adrenoceptor agonists were administered to most veterinary patients, particularly in large felids, in which hyperkalaemia was reported 8,11–14,17 . Medetomidine inhibits endogenous insulin, cortisol and catecholamine release 44,62,63 .…”

“…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.…”

“…This was best seen in case three, where aBG analysis was regularly performed during the procedure. The scientific evidence suggests that the long duration of anaesthesia [5][6][7]9,12,17 and use of medetomidine 8,10,[12][13][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.…”

“…7 It has also been documented in numerous non-domestic felids, [11][12][13][14][15] domestic cats 16,17 and in a calf. 18 In veterinary species, theories about its association with the stress response and depletion of endogenous catecholamines, 8,9,14 acidaemia, [6][7][8]10,14,16,18 use of α 2 -adrenoceptor agonists 8,10,[12][13][14][16][17][18] and other drugs, [6][7][8][9][10][12][13][14][16][17][18] duration of anaesthesia, [5][6][7]9,10,12,15,17 plasma hyperosmolarity, 8,10 ischaemia-induced cellular lysis 10,18 and genetic susceptibility 6,7,…”

“…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. 18 In veterinary species, theories about its association with the stress response and depletion of endogenous catecholamines, 8,9,14 acidaemia, [6][7][8]10,14,16,18 use of α 2 -adrenoceptor agonists 8,10,[12][13][14][16][17][18] and other drugs, [6][7][8][9][10][12][13][14][16][17][18] duration of anaesthesia, [5][6][7]9,…”