Resuscitation from transfusion-associated hyperkalaemic ventricular fibrillation

Evidence to guide resuscitation from transfusion-related hyperkalaemic ventricular fibrillation is sparse. This case report describes a 29 kg patient undergoing scoliosis surgery who developed hyperkalaemic ventricular tachycardia/fibrillation following the replacement of over two blood volumes with...

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Bibliographic Details
Published in:Anaesthesia and intensive care 2007-02, Vol.35 (1), p.110-113
Main Author: Woodforth, I J
Format: Article
Language:English
Subjects:
Adolescent
Calcium chloride
Calcium Chloride - administration & dosage
Care and treatment
Case studies
Dosage and administration
Drug Therapy, Combination
Equipment Failure
Humans
Hyperkalemia
Hyperkalemia - drug therapy
Hyperkalemia - etiology
Hypoglycemic Agents - administration & dosage
Insulin
Insulin - administration & dosage
Intraoperative Complications - etiology
Intraoperative Complications - therapy
Lidocaine
Male
Methods
Orthopedic surgery
Prevention
Resuscitation - methods
Risk factors
Scoliosis
Scoliosis - surgery
Transfusion Reaction
Ventricular fibrillation
Ventricular Fibrillation - etiology
Ventricular Fibrillation - therapy
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Summary:Evidence to guide resuscitation from transfusion-related hyperkalaemic ventricular fibrillation is sparse. This case report describes a 29 kg patient undergoing scoliosis surgery who developed hyperkalaemic ventricular tachycardia/fibrillation following the replacement of over two blood volumes with banked blood in 90 minutes. Rapid reversion to sinus rhythm followed administration of 1.4 mmol of calcium chloride and two units of insulin (Actrapid, Novo Nordisk). The relevant literature is reviewed, indicating that an elevated serum ionised calcium level protects against hyperkalaemia, by an intracellular mechanism. Evidence supports the use of lignocaine, but not amiodarone, as additional treatment.
ISSN:0310-057X
1448-0271
DOI:10.1177/0310057X0703500117