Resuscitative Hyperkalemia in Noncrush Trauma

Abstract

The trauma patient is exposed to physiologic processes and life-saving interventions that predispose to hyperkalemia. Severe elevations in potassium levels subject this compromised patient to additional cardiac risks in the periresuscitative period. Recent advances in the care of the massively traumatized patient may or may not increase the risk for hyperkalemia. This prospective, observational study was undertaken to define the period prevalence of hyperkalemia (plasma potassium level >5.5 mmol/L) in a noncrush trauma population during the initial resuscitative period and to identify potential risk factors for the development of hyperkalemia. A total of 131 patients were studied during the initial 12 h after admission for noncrush trauma. The period prevalence of hyperkalemia was 29.0%. Hyperkalemic patients had dramatic shifts in plasma potassium levels compared with nonhyperkalemic patients. Five patients, all from the hyperkalemic group, died. By multivariate logistic regression analysis, independent risk factors for hyperkalemia were an emergency department plasma potassium level of 4.0 mmol/L or higher (relative risk 3.40; 95% confidence interval 1.17 to 9.84; P ‫؍‬ 0.024 versus baseline potassium level <4.0 mmol/L) and transfusion of cell-or plasma-based products (relative risk 10.56; 95% confidence interval 3.62 to 30.78; P < 0.001 per log-transformed unit). The prevalence of hyperkalemia during trauma resuscitation was not reported previously. Given the arrhythmic risks of hyperkalemia, particular caution is necessary with trauma patients who present with plasma potassium levels >4.0 mmol/L and require aggressive transfusion support.

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

“…The most common RRT indication was hyperkalemia (69%), followed by azotemia (51%), volume overload (49%), and acidosis (45%). This was consistent with the clinical situation -rhabdomyolysis, large-volume resuscitation with blood products (38,39), hypercatabolism, and frequent (often daily) surgery. Often, RRT was required within days of initial injury; 59% required initiation before reaching the United States.…”

Hyperkalemia Following Massive Transfusion in Trauma

“…This occurs as a result of the massive release of intracellular potassium and nephrotoxic effects of myoglobin. A recent study suggests that hyperkalemia in non-crush, non-burn trauma patients is a result of neuromuscular blockade, rewarming techniques, massive transfusions, and rate of infusion of blood products [15]. With the recent increased use in massive transfusion strategies to address hemorrhagic shock in trauma, concerns have arisen regarding the development of hyperkalemia in this population.…”

“…The authors noted that those patients receiving packed red blood cells during that period of resuscitation were at an increased risk of hyperkalemia. Perkins assessment of this same population noted that initial potassium values greater than 4.0 mEq/L placed the trauma patient at a significant risk of developing hyperkalemia during their resuscitation [15].…”

“…These protocols have been associated with a reduction in multiple organ failure, ventilator associated pneumonia, and abdominal compartment syndrome. However, military data has implicated large-volume blood transfusions in the development of hyperkalemia [14,15]. Aboudara and colleagues recently presented an analysis of 131 ''non-crush'' trauma patients undergoing resuscitation during the initial 12 h after admission to a combat support hospital [14].…”

Emergency Department Thoracotomy: an Update

“…The reported prevalence of hyperkalemia is 29 % [17]. Independent risk factors for hyperkalemia include an ED plasma potassium level of 4.0 mmol/L or higher (relative risk 3.40; 95 % confidence interval 1.17 to 9.84; p=0.024 vs. baseline potassium level <4.0 mmol/L) and transfusion (relative risk 10.56; 95 % confidence interval 3.62 to 30.78; p<0.001).…”