Highest/lowest electrolytes you've seen?

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abolt18

abolt18

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Had a bit of a surprise a while back. Generic outpatient eye surgery, doesn't tolerate MAC so we do general with LMA. Super brady during the case, refractory to usual interventions (glyco, atropine, ephedrine, 10-20mcg dose EPI, surgeon stops touching eye for a while). Starts having some junctional beats with HR down to 20s. Pads put on to pace if needed. Surgery aborted.

PACU, his potassium level is 8.0! That is probably the highest serum potassium I've ever seen on a patient who was not coding... though I suspect he was not very far away from that happening.

He spent a few days in the hospital getting that fixed and went back to finish the eye surgery over the weekend.

Just curious what others have run into.
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abolt18 said:
Had a bit of a surprise a while back. Generic outpatient eye surgery, doesn't tolerate MAC so we do general with LMA. Super brady during the case, refractory to usual interventions (glyco, atropine, ephedrine, 10-20mcg dose EPI, surgeon stops touching eye for a while). Starts having some junctional beats with HR down to 20s. Pads put on to pace if needed. Surgery aborted.

PACU, his potassium level is 8.0! That is probably the highest serum potassium I've ever seen on a patient who was not coding... though I suspect he was not very far away from that happening.

He spent a few days in the hospital getting that fixed and went back to finish the eye surgery over the weekend.

Just curious what others have run into.
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any classic EKG changes suggestive of hyperkalemia such as peaked T-waves? Why would you have thought to check potassium level unless you pan-lab everything? dialysis patient, and if so, medical compliance issues?

The highest non-hemolyzed K+ i've seen in a living, non-coding patient is 10.4 = overdosed and found down with compartment syndrome
The lowest Na+ i've seen in a living, non-coding patient is 102 = drank too much water
 
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EKG normal. Has CKD 4 but had stable labs for years, most recent ~6 months ago.

Had this operation on the other eye a month ago. I felt pretty comfortable without getting labs... Until we didn't.

Ultimate reason. PCP had increased his spironolactone 3-4 months prior from 25mg qd to 100mg BID for BLE edema but never checked any labs afterward.
 
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The best are the calls I get from the gas lab after sending them a corporal gas aspirate in a priapism. pO2 10. pCO2 90. PH 6.5.

“Uhhhh, your patient is dead”
 
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Calcium 15. Emergency case.
Can’t remember If pt had underlying pth tumor or paraneoplastic syndrome.
0.9%NaCl and lasix usually helps resolve it acutely. Diurese or dialyze.
 
Highest K: 11.2. CKD with some dead muscle who also had skipped some dialysis. Lab said it wasn’t hemolyzed. Lived.
Lowest i-cal: 0.04. Parathyroid who had gone home. Positive Tchvostek and Rousseau. Got repleted, did fine.
Highest pCO2: our machines stop reporting somewhere north of 100. Has happened twice, no long term survivors yet.
Lowest surviving: pH 6.8. Peds trauma, did well after the hepatic artery got fixed. Kids are tough.
 
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coffeebythelake said:
any classic EKG changes suggestive of hyperkalemia such as peaked T-waves? Why would you have thought to check potassium level unless you pan-lab everything? dialysis patient, and if so, medical compliance issues?

The highest non-hemolyzed K+ i've seen in a living, non-coding patient is 10.4 = overdosed and found down with compartment syndrome
The lowest Na+ i've seen in a living, non-coding patient is 102 = drank too much water
Click to expand...

How did the 102 sodium do? Can’t imagine they went for a procedure. Did they give hypertonic saline?
 
Not an electrolyte, but I once saw a hemoglobin of 3.4 in a patient going for an endoscopy.
 
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abolt18 said:
EKG normal. Has CKD 4 but had stable labs for years, most recent ~6 months ago.

Had this operation on the other eye a month ago. I felt pretty comfortable without getting labs... Until we didn't.

Ultimate reason. PCP had increased his spironolactone 3-4 months prior from 25mg qd to 100mg BID for BLE edema but never checked any labs afterward.
Click to expand...
Don’t know that I’ve ever seen 100 bid of aldactone?! Def not to treat LE edema.
 
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WinslowPringle said:
Highest K: 11.2. CKD with some dead muscle who also had skipped some dialysis. Lab said it wasn’t hemolyzed. Lived.
Lowest i-cal: 0.04. Parathyroid who had gone home. Positive Tchvostek and Rousseau. Got repleted, did fine.
Highest pCO2: our machines stop reporting somewhere north of 100. Has happened twice, no long term survivors yet.
Lowest surviving: pH 6.8. Peds trauma, did well after the hepatic artery got fixed. Kids are tough.
Click to expand...
CO2: I find hypercapnia is fairly benign and its adverse effect are vastly overstated when the patient is ventilated and not spontaneously breathing. It is the low oxygen levels that are the problem.

Lowest Hemoglobin: *** (our machine didn't calculate below 3.0. JW child)
Lowest K: 3.3 (gave calcium and bicarb just in case)
 
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BobLoblaw78 said:
CO2: I find hypercapnia is fairly benign and its adverse effect are vastly overstated when the patient is ventilated and not spontaneously breathing. It is the low oxygen levels that are the problem.

Lowest Hemoglobin: *** (our machine didn't calculate below 3.0. JW child)
Lowest K: 3.3 (gave calcium and bicarb just in case)
Click to expand...

Lowest K is 3.3? I assume that was supposed to be something else.
 
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abolt18 said:
Lowest K is 3.3? I assume that was supposed to be something else.
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Nah, the potassium was really that low! And the SpO2 went all the way down to 94%. Pretty sick pt!!!!! OMG!!!

JK, that was for s&g's! (but Hg was legit)
 
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Highest/lowest electrolytes you've seen?​

I saw electrolytes with 40mg of ketamine.
That was pretty high.
 
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thinkorswim said:
Not an electrolyte, but I once saw a hemoglobin of 3.4 in a patient going for an endoscopy.
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you beat me. Had a hgb of 3.5 in a young trauma patient, survived.

Unrelated to electrolytes, but once saw an icu nurse accidentally bolus an epi bag, BP got into the high 270’s systolic before we got it down. Patient survived that event, no idea if they made out of the icu
 
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In residency I saw a HCT in the low 70s in a 30 something year old who had survived some congenital cyanotic heart disease. Chronically on oxygen, lived with sats in the mid 70s at baseline. We were doing some pacemaker procedure if I remember right, like a lead exchange or something. The A-line looked like venous blood, but pulsatile. The thing that stuck out the most to me though was when we had to put a central line in her. When we did the manometry, the blood was almost black and it stuck to the side walls of the tubing as it slowly drifted down because it was so viscous. I can't remember the ABG but definitely one for the books.
 
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Volatile said:
you beat me. Had a hgb of 3.5 in a young trauma patient, survived.

Unrelated to electrolytes, but once saw an icu nurse accidentally bolus an epi bag, BP got into the high 270’s systolic before we got it down. Patient survived that event, no idea if they made out of the icu
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Highest Bp I’ve seen was 312. A lot of Epi was given that wasn’t circulating… well until it did
 
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patriot6 said:
I’ve seen 350.
Drug error.
Bolus of concentrated levo.
Patient woke up fine.
Changed my pants between cases.
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I did that once. Used to dosing norepi in mcg/min. I was at a new hospital, didnt catch that they programmed their pumps for weight based. Arterial line just showed up arrows. Immediately realized what I did, turned off pump, dumped an ungodly amount of propofol into patient. BP came down nicely. Guy woke up absolutely fine, no problems.
 
DocVapor said:
I did that once. Used to dosing norepi in mcg/min. I was at a new hospital, didnt catch that they programmed their pumps for weight based. Arterial line just showed up arrows. Immediately realized what I did, turned off pump, dumped an ungodly amount of propofol into patient. BP came down nicely. Guy woke up absolutely fine, no problems.
Click to expand...
Walked in after a call for help from accidental bolus 10mg vial neo. Systolic 280s. It was the heart rate of 15 for five minutes that was scary. Propofol and atropine and wait. Patient luckily did ok too
 
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easeofmind said:
Highest Bp I’ve seen was 312. A lot of Epi was given that wasn’t circulating… well until it did
Click to expand...
We took a young lady to the OR for an ex lap who was a couple days into her hospital stay after MVC and had already received >100u blood products.

After I had given a few units of blood, I gave a gram of CaCl. When the BP shot up to >300 systolic I looked down and saw that the premade syringe of CaCl was actually a premade syringe of Epi.

My attending had asked an anesthesia tech to open and put together one of the things of calcium before we went to get the patient. For reasons unknown they opened a calcium AND an epi and put them next to each other. (They look AWFULLY similar)

This is obviously my own bad for not double checking the drug before it was administered. I learned a few good lessons that day. The BP came down about 5 minutes later. I honestly don't remember what I gave to bring it down. I just remember the terror I felt.
 
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nimbus said:
Are these all Jehovah’s Witnesses?
Click to expand...

The second patient was. They got the bleeder in IR and made it maybe 2 days in icu. The first one was transfused to almost 8 before I saw them but was an alcoholic cirrhosis hepatic encephalopathy etc.
 
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