Repeated hyperkalaemia during two separate episodes of general anaesthesia in a nine-year-old, female neutered greyhound

Abstract

There is an increasing awareness of the development of hyperkalaemia during anaesthesia in otherwise healthy veterinary patients. In the human literature 63 per cent of in-hospital hyperkalaemic episodes are associated with drug administration. Anecdotal veterinary reports have suggested that a genetic component may also play a role, with greyhounds seemingly more susceptible to the development of hyperkalaemia under anaesthesia. This case report identifies the repeated development of hyperkalaemia, and its treatment, during two separate episodes of general anaesthesia in a nine-year-old, female neutered greyhound. The first episode of hyperkalaemia (7.89 mmol/l) was identified due to bradycardia and second-degree atrioventricular block on electrocardiogram. Treatment was with intravenous calcium gluconate, insulin, glucose and fluid therapy. The second episode (6.60 mmol/l) was associated with spiked T-waves, and treatment was with insulin and glucose infusions to allow completion of the anaesthetic and surgery. Possible causes and treatments are discussed, and the need for reporting of such cases is highlighted.

Life‐threatening hyperkalaemia in a five‐year‐old rottweiler undergoing bilateral elbow arthroscopy

“…In 2018, Taylor and others1 reported on over 20 dogs developing intraoperative hyperkalaemia. Another recent case of hyperkalaemia developing during general anaesthesia, on two separate occasions, has been reported in a greyhound 2. In these reports, hyperkalaemia appeared after 120 minutes and between 60 and 90 minutes, respectively.…”

“…In these reports, hyperkalaemia appeared after 120 minutes and between 60 and 90 minutes, respectively. In both cases hyperkalaemia could not be attributed to a specific cause, but was suggested to potentially be the result of the combination of drugs used, respiratory acidosis, fluid administration and a potential genetic component 1 2. Other than in dogs, there have been several reports of hyperkalaemia occurring during anaesthesia of large non‐domestic felids (anaesthetised with medetomidine or dexmedetomidine, ketamine and isoflurane) 3–5.…”

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

“…Potassium is the main intracellular cation and plays an essential role generating and maintaining the resting cell membrane potential and contributing to normal cell growth 1. 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.…”

“…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.…”

“…ECG alterations may not always occur and measurement of plasma potassium should be used to monitor changes over time 4 21. Therefore, treatment of acute hyperkalaemia should aim to stabilise the cardiac myocyte excitability and to reduce extracellular potassium concentration 2 3…”