How high of a potassium

[Lee123]

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Simple pole:

If the high K value for your lab is 5.1, how high will you allow for an elective case if you do not plan on using Sux and there are no ECG changes?

 

[pgg]

Not so simple. Is the hyperkalemia chronic or acute? What's the case? Comorbidities?

If there was an evidence-based universal answer to the go/no-go hyperkalemia question for all comers, it wouldn't keep coming up.

 

[Idiopathic]

if you can explain the hyperkalemia (chronic renal insufficiency or even chronic high potassium), then Ill go back with a stable potassium in the mid 5's, maybe higher. but if someone has a potassium of 5.3 on a one-off preop lab, i think its prudent to delay an elective case to recheck it or work it up.

also, if you are afraid of using sux in someone with K of 5.2 then maybe you shouldnt take them back at all, because a small acidosis (pH from 7.42 to 7.3) could result in a larger delta K than a dose of sux.

 

[aneftp]

Done tons of vascular cases when I started out as attending for 3-4 years at major tertiary medical center. Our cut off was 6.0. Yes 6.0. This was written policy within surgery and anesthesia department . But we also did routine renal labs and EKG on all patients DOS and always correlated with patients history and exam. Most of these renal patients are chronically hyperkalemic and will tolerate it.

The vascular guys were super fast. Av fistula in less than 30 minutes.

 

[jetproppilot]

Simple pole:

If the high K value for your lab is 5.1, how high will you allow for an elective case if you do not plan on using Sux and there are no ECG changes?

There is no right answer to your question.

I can tell you in sixteen years of private practice I can count on one hand the number of cases I've cancelled because of a high potassium.

The posts above me are accurate.

I will add to them:

We all have taken care of renal patients that have these

WACKED OUT POTASSIUM NUMBERS.

Are you taking care of an ESRD pt with a K+ of 6.0 that drastically needs his AV graft revised?

THATS DOABLE. I'd do it.

OR

Have you been blindsided by the known diabetic/hypertensive/obese really nice lady who bored you with stories of her grand kids

up for an elective total knee revision and

HER

potassium is 6.0?

There's

SO MANY SCENERIOS, DUDE,

that there's not ONE

right answer to your question.

We can delve into this more later but in an attempt to answer briefly:

1) I tolerate high K+ in known renal patients who need surgical procedures that will increase their quality of life

2)If you get a high K+ in a patient you don't expect it, repeat it because it's probably wrong since if blood sits around too long the K+ value climbs

3)If you find that (VERY RARE) TRUE 6.0 K+ WHEN YOU WEREN"T EXPECTING IT and the case is ELECTIVE, cancel. Just to reemphasize, this is a very very rare occurence...not something residents should fret about

4) If you've got a K+ that's OFF THE CHARTS...say 7.0...but the dude needs surgery..emergent CABG...AAA....etc...deal with it like I know you know how.

Of course there's a gray area.

That

gray area.....is this really an emergency? Is the K+ really too high to do this case?

THAT

is what makes you valuable as an anesthesiologist.

Proceeding when it is safe and cancelling when it is not.

That's why we make the big bucks.