Heparin-Induced Hyperkalemia Following Heart Surgery: A Case Report

Document Type : Case Report

Authors

1 Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Heparin is widely used in patients undergoing cardiac surgeries on cardiopulmonary bypass; however, it can cause some complications, mainly including bleeding and thrombocytopenia. Heparin-induced hyperkalemia is a rare and less recognized adverse effect of heparin therapy that can lead to serious morbidities. Herein, we describe a 69-year-old Caucasian woman with coronary artery disease who underwent coronary artery bypass graft surgery. The postoperative electrocardiogram was normal without any signs of ischemia or arrhythmia. After the patient was transferred to the intensive care unit, her potassium level was 5.8 mEq/L, which remained high. She had not perioperatively received any causative agent of hyperkalemia. All laboratory tests were within normal ranges. Despite adequate diuresis, a relatively steady state of renal function, and hyperkalemia treatment, including intravenous glucose and furosemide and insulin infusion, the patient’s potassium level increased progressively. All etiologies of hyperkalemia were ruled out, and consequently heparin-induced hyperkalemia was suspected. (Iranian Heart Journal 2023; 24(2): 104-107)

Keywords


  1. Murray DW, Jaques LB, Perrett TS, Best CH. Heparin and Vascular Occlusion. Canadian Medical Association journal 1936; 35:621-622.
  2. Truhlar A, Deakin CD, Soar J, Khalifa GE, Alfonzo A, Bierens JJ, Brattebo G, Brugger H, Dunning J, Hunyadi-Anticevic S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201.
  3. Palmer BF, Clegg DJ. Diagnosis and treatment of hyperkalemia. Cleveland Clinic journal of medicine 2017; 84:934-942.
  4. Day JR, Chaudhry AN, Hunt I, Taylor KM. Heparin-induced hyperkalemia after cardiac surgery. The Annals of thoracic surgery 2002; 74:1698-1700.
  5. Gonzalez-Martin G, Diaz-Molinas MS, Martinez AM, Ortiz M. Heparin-induced hyperkalemia: a prospective study. International journal of clinical pharmacology, therapy, and toxicology 1991; 29:446-450.
  6. Oster JR, Singer I, Fishman LM. Heparin-induced aldosterone suppression and hyperkalemia. The American journal of medicine 1995; 98:575-586.
  7. Bhaskar B, Fraser JF, Mullaney D. Lest we forget: heparin-induced hyperkalemia. Journal of cardiothoracic and vascular anesthesia 2012; 26:106-109.
  8. Sherman DS, Kass CL, Fish DN. Fludrocortisone for the treatment of heparin-induced hyperkalemia. The Annals of pharmacotherapy 2000; 34:606-610.