Abstract
ROLE OF FLUDROCORTISONE IN TREATMENT OF HEPARIN-INDUCED HYPERKALEMIA: A CASE REPORT OF RARE ASSOCIATION

Saud Al-ezzi*, Philip Oreoluwa, Fatima Inam, Sujan Poudel, Ayodeji Adegunwa, Anurag A. Anghole, Khadija Qureshi

ABSTRACT

Heparin is an intravenous anticoagulant used in treating and prophylaxis of pulmonary thromboembolism, deep vein thrombosis, and post-myocardial infarction patients. A rare adverse effect of heparin reported is hyperkalemia, which manifests within a few days of therapy initiation. Here we report a case of a 71-year-old African American male patient presented to the ED via Dermatology Clinic for IV antibiotics for a stasis ulcer on his right lower leg, which has been exacerbating for the last seven months. Past medical history is significant for CKD stage IV with a baseline creatinine of 2.7 mg/dL secondary to uncontrolled hypertension, thoracic aortic dissection s/p repair three years ago, and essential thrombocytosis. On admission, his labs were Na+ 130 mEq/L, K+ 5.2 mEq/L, creatinine 2.98 mg/dL. The patient was started on subcutaneous heparin 5000 units twice daily, and K+ rose to 6.1 mEq/L. The patient was started on fludrocortisone, and his K+ started trending down slowly over days. Fludrocortisone (FCA) is a synthetic glucocorticoid with strong mineralocorticoid activity and moderate glucocorticoid activity.

Keywords: Pulmonary thromboembolism, deep vein thrombosis, and post-myocardial infarction patients.


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