Treatment of life-threatening hyperkalemia with peritoneal dialysis in the ED

Severe hyperkalemia (serum potassium N 7.0 mmol/L) is an uncommon electrolyte abnormality in patients undergoing maintenance peritoneal dialysis (PD). Hemodialysis (HD) has been suggested as the definitive therapy for severe hyperkalemia in this population,although there is limited data regarding re...

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Bibliographic Details
Published in:The American journal of emergency medicine 2015-03, Vol.33 (3), p.473.e3-473.e5
Main Authors: Roseman, Daniel A., MD, Schechter-Perkins, Elissa M., MD, MPH, Bhatia, Jasvinder S., MD
Format: Article
Language:English
Subjects:
Cardiac arrhythmia
Catheters
Dialysis
Electrocardiography
Emergency
Emergency medical care
Emergency Service, Hospital
Hospitals
Humans
Hyperkalemia - therapy
Intensive care
Male
Middle Aged
Peritoneal dialysis
Peritoneal Dialysis - methods
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Summary:Severe hyperkalemia (serum potassium N 7.0 mmol/L) is an uncommon electrolyte abnormality in patients undergoing maintenance peritoneal dialysis (PD). Hemodialysis (HD) has been suggested as the definitive therapy for severe hyperkalemia in this population,although there is limited data regarding renal replacement options.We report a case of life-threatening hyperkalemia with electrocardiogram changes in a nonadherent PD patient who was successfully treated with standard medical therapy and manual exchanges initiated by emergency department (ED) personnel. The patient did not require HD. This case demonstrates the potential utility of PD as a treatment option for severe hyperkalemia in established dialysis patients when EDs are prepared to deliver exchanges. This report maybe particularly relevant due to the increasing prevalence rate of PD and for centers with limited HD access.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2014.08.041