HEPARIN INDUCED HYPERKALEMIA IN A HOSPITALIZED PATIENT: A CASE REPORT OF RARE ASSOCIATION
Udoh A. Effiong*, Gloria Reng, Falade A. Samuel, Naglaa Ghobriel, Amina B. Shah and Muhammad Irfan
ABSTRACT
Heparin induced hyperkalemia is a rare casue of hyperkalemia especially in the hospitalized patients with co-morbidities such as diabetes, chronic kidney disease etc. Heparin has the potential to induce hyperkalemia due to decreased aldosterone synthesis. Here we report two cases of elderly patients developing hyperkalemia due to heaprin use. A 73 year old male was admitted to the hospital from ED with altered mental status and found to have Acute on Chronic kidney injury complicated by uremia. Labs on admission were Na+ 132 mEq/L, K+ 5.6 mEq/L, Creatinine 3.19 mg/dL. Past medical history was significant for CKD and Type 2 DM. Patient was started on subcutaneous heparin and the potassium rose to 6 mEq/L at the end of the day. Patient was started on Fludrocorticosterone and the potassium started drowntrending. Due to ischemic findings, patient was given heparin again which made the potassium rise again thus making it the clear cause of hyperkalemia in this patient. Although all patients who receive heparin may have reduced aldosterone levels, most are able to compensate through increased renin production and therefore remain asymptomatic. However, patients on prolonged heparin therapy or those unable to adequately increase renin production (e.g., patients with diabetes or renal insufficiency) may develop hyperkalemia. Fludrocotisone can be used as a potential treatment for the hospitalized patients who need to be on the heparin treatment.
Keywords: Fludrocorticosterone, drowntrending, Creatinine.
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