Recurrent Hyperkalemia During General Anesthesia in a Dog

Abstract

Objective: To describe the development of recurrent hyperkalemia in a dog that underwent general anesthesia at two different hospitals within a month. The definitive underlying cause of the hyperkalemia remains unknown. Case summary: A 11 year-old male neutered Rottweiler underwent general anesthesia on two separate occasions at two different hospitals for ophthalmic surgery within a month and developed marked hyperkalemia on each occasion. The patient received similar drug protocols in both instances, including propofol, midazolam, non-depolarizing neuromuscular blocking agents, and isoflurane inhalant anesthetic. The patient showed ECG changes consistent with hyperkalemia during the first anesthetic event, but not the second. No underlying cause of hyperkalemia was definitively identified. The patient responded to standard therapy for hyperkalemia on both occasions and serum potassium levels returned to normal. The patient was discharged from the hospital without further complications and post-operative rechecks showed persistently normal serum potassium levels. New or unique information provided: Considering that there is a relationship between the development of severe hyperkalemia and propofol administration in human patients, it is possible that such a relationship exists in veterinary patients. However, numerous other diseases and medications can also lead to peri-operative hyperkalemia. Veterinary professionals should be aware that hyperkalemia can develop intra-operatively and remains be an important differential diagnosis in bradycardic patients under anesthesia that are not responding to traditional therapies.

Hyperkalaemia during two consecutive anaesthetics in an aggressive Bengal cat

“…We describe a recurrence of hyperkalaemia in the same animal when anaesthetised for orthopaedic procedures on two separate occasions. Two cases of recurrent hyperkalaemia have been documented in dogs, 8,12 but to the authors’ knowledge, this is the first case of recurrent hyperkalaemia during general anaesthesia in a domestic cat. We could not identify a single definitive cause, but it is possible that the development of hyperkalaemia may be multifactorial in nature.…”

“…6 Unanticipated, severe hyperkalaemia can develop acutely during general anaesthesia and requires prompt recognition and treatment. Several cases are reported in dogs, [7][8][9][10][11][12] non-domestic large felids [13][14][15][16][17][18] and horses. [19][20][21][22][23] Unexpected hyperkalaemia in a domestic cat during general anaesthesia has been recently reported, 24 and in other cats in which the cause has been attributed to hyperacute rhabdomyolysis 25 and malignant hyperthermia (MH).…”

Life‐threatening hyperkalaemia during general anaesthesia in a domestic short‐haired cat

“…If severe, hyperkalaemia, which can develop acutely during general anaesthesia,2 3 can be life‐threatening,4 5 and prompt recognition and treatment are essential. This has been reported in dogs, mainly greyhounds, but also in other breeds,2 3 6–9 large non‐domesticated cats10–12 and horses 13 14. To date, reports of the development of hyperkalaemia in anaesthetised domestic cats have been caused by peracute rhabdomyolysis15 and malignant hyperthermia 16–18.…”

Hyperkalemia in Four Anesthetized Red Wolves (Canis Rufus)

“…2 Greyhounds have been documented to develop hyperkalemia during anesthesia as well as during pregnancy, and a recent case report in a Rottweiler documented recurrent hyperkalemia during anesthesia, with no definitive cause identified. 5,11,18 Nonanesthetic causes of hyperkalemia in veterinary patients include acidemia, malignant hyperthermia, rhabdomyolysis, thrombosis, and genetic causes such as hyperkalemic periodic paralysis in horses. 5,10 Hyperkalemia can be a fatal electrolyte disturbance causing bradycardia and, potentially, cardiac arrest if not adequately managed.…”