2013, Number 2
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Rev Mex Traspl 2013; 2 (2)
Management of transoperative hyperkalemia in patients with chronic renal failure subjected to renal transplantation
Villegas-Anzo F, Castellanos-Olivares A, Gracida-Juárez C, Rangel-Montes MA, Espinoza-Pérez R, Cancino-López J
Language: Spanish
References: 20
Page: 50-57
PDF size: 232.30 Kb.
ABSTRACT
Introduction: The kidney transplantation is the therapeutic alternative
to improve the quality of the patient’s life with chronic
renal insufficiency; the anesthesiologist should be take account
the characteristic physiopathology for the prevention of the complications
perioperative that include four general conditions:
hyperkalemia, metabolic acidosis, hypertension and azotemia.
The hyperkalemia represents the most important ionic disorder
to correct in the treatments of urgency; the evaluations in the
literature have demonstrated that the infusion of glucose hypertonic
(polarizing solution) with insulin is more effective than
(conventional treatment) with bicarbonate, gluconate of calcium
and hyperventilation.
Objectives: To demonstrate that the decrease
of the values on plasma of potassium is bigger when administers
himself bicarbonate, gluconate of calcium and hyperventilation
in comparison with glucose hypertonic and insulin.
Design: Prospective, comparative and cuasiexperimental study.
Material and methods: 54 patients were studied with levels
subjected high plasma potassium concentrations to surgery of
kidney transplantation from January 1990 to December 1997.
Results: Were formed two groups, one managed with conventional
treatment and other with glucose hypertonic with insulin
treatment 30 patients were formed managed with conventional
treatment being reported levels plasma of K in 6.29 ± 0.43
mEq/L the treatment preoperative was 91.7% of patients with
dialysis and 8.3% with hemodialysis, with age average 33 ± 8.8
years, weight 55 ± 9.9 kg. Group II: solution glucose and insulin the initial levels of K was 7.01 ± 0.66 with descent up to 4.39
± 0.74 mEq/L, the treatment perioperative it was the peritoneal
dialysis in 23 patients (76.7%) and seven with hemodialysis
(23.3%), with average 36 ± 14 years and weight 52 ± 13.7 kg.
Conclusions: The subjected patients to treatment with glucose
an insulin had bigger descent of the levels plasma of K without
tendency to their increase that with the conventional treatment
of bicarbonate, hyperventilation and gluconate of calcium.
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