Hyperkalemia, Bradycardia, and Cardiac Arrest during Percutaneous Declotting of an Arteriovenous Graft

 

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Hyperkalemia is a common problem in patients with acute or chronic renal failure as the kidneys are typically responsible for 80 to 90% of daily potassium excretion.[1] Those presenting for declotting procedures of dialysis access shunts are at elevated risk of hyperkalemia as they often have recently received incomplete dialysis.[2] Noncardiac symptoms of hyperkalemia are usually subtle and may include fatigue, paresthesias, and skeletal muscle weakness.[3] However, due to its effects on the cellular membrane resting potential, elevated serum potassium can lead to several cardiac arrhythmias, ranging from benign to ventricular fibrillation and asystole.[4] Although not commonly associated with hyperkalemia, dialysis patients with elevated serum potassium may develop bradycardia,[5] which as seen in this case can occur during a declotting procedure and is a potentially life-threatening sequela.

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Brian FunakiM.D. 

Section of Vascular and Interventional Radiology, University of Chicago Medical Center

5840 S. Maryland Avenue, MC 2026, Chicago, IL 60637