Metabolic changes in surface-induced deep hypothermia combined with cardiopulmonary bypass for cardiac surgery

Hypokalemia (mean serum potassium 2.3 +/- 0.4 mEq/l) was observed in six hypothermic patients (30 degrees - 32 degrees C) with head injuries or brain hypoxia. In the first three patients, potassium was administered to maintain serum levels above 3.5 mEq/l and on rewarming after 48 h of hypothermia hyperkalemia (peak serum potassium = 7.1 +/- 0.5 mEq/l) associated with cardiac arrhythmias developed. The remaining three patients received sufficient potassium to approximately replace measured losses during the hypothermic period. These patients did not become hyperkalemic on rewarming. Clinically insignificant sinus bradycardia, premature atrial contractions and junctional rhythms were seen during hypothermia with hypokalemia. We conclude that hypothermia produces hypokalemia by a shift of potassium from the extracellular to intracellular or extra vascular spaces. Potassium therapy during controlled hypothermia in the range 30 degrees - 32 degrees C should only replace measured losses.

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Serum potassium levels during prolonged hypothermia

Koht

Cane

Cerullo

1983

Intensive Care Med

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The role of the liver in the changes of acid-base balance and plasma lipids during surface-induced deep hypothermia

Shida

Morimoto

Inokawa

et al. 1977

The Japanese Journal of Surgery

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The role of the liver in the changes of acid-base balance and plasma lipids in surface-induced deep hypothermia for open-heart surgery was investigated clinically and experimentally. The metabolic acidosis generally observed in open-heart surgery under surface-induced deep hypothermia is derived from lactacidemia. Although the accelerated anaerobic glycolysis is partly responsible, the depressed acidic metabolite-disposing ability of the liver also plays an important role. The evidence which is presented to show the decrease of plasma lipids other than NEFA under hypothermia is probably due to the hepatic accumulation of lipids and the decreased lipids release from the liver.

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Studies of lipid and carbohydrate metabolism during surface-induced deep hypothermia with circulatory arrest for open-heart surgery

Shida

Morimoto

Inokawa

et al. 1977

The Japanese Journal of Surgery

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Plasma lipids, blood glucose, plasma insulin (IRI) and serum dopamine-beta-hydroxylase (DBH) were measured in 30 subjects undergoing surface-induced deep hypothermia with circulatory arrest for open-heart surgery. Non-esterified fatty acid (NEFA) in the plasma rapidly increased at the lowest temperature (23 degrees C) reached and other lipids in the plasma decreased during the cooling period. An increase of NEFA and a decrease of triglyceride have been attributed to the action of lipoprotein lipase activity stimulated by heparin. It is also likely that the decrease of other lipids and beta-lipoprotein in the plasma results from the transient hypofunction of the liver due to hypothermia. Blood glucose increased during the cooling period, while plasma insulin showed no significant change. Serum DBH reflecting catecholamine also showed no significant change during the cooling or rewarming periods. Therefore, hyperglycemia in hypothermic open-heart surgery may result from the decrease of peripheral utilization of glucose and from the inhibition of insulin secretion due to the transient pancreatic hypofunction.

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Metabolic changes in surface-induced deep hypothermia combined with cardiopulmonary bypass for cardiac surgery

Cited by 5 publications

References 17 publications

Serum potassium levels during prolonged hypothermia

Serum potassium levels during prolonged hypothermia

The role of the liver in the changes of acid-base balance and plasma lipids during surface-induced deep hypothermia

Studies of lipid and carbohydrate metabolism during surface-induced deep hypothermia with circulatory arrest for open-heart surgery

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