Case reportLife-threatening hyperkalemia during radiofrequency ablation of hepatocellular carcinoma
Introduction
Radiofrequency ablation (RFA) of unresectable hepatic malignancies is considered a safe treatment, with low mortality and morbidity [1], [2]. The more commonly reported complications include bleeding, impairment of liver function, infection, and biliary tract damage [1], [2]. Acute life-threatening hyperkalemia leading to intraoperative ventricular arrhythmia has not been previously reported. A case of wide complex tachycardia secondary to hyperkalemia in a patient undergoing laparoscopic RFA of a large hepatocellular carcinoma is presented. Approval for the use of deidentified personal health information contained in this report was obtained in accordance with University of Washington guidelines.
Section snippets
Case report
A 48 year-old man with a diagnosis of hepatitis C-related cirrhosis and recent upper gastrointestinal bleeding from gastric varices, had a large 9.3 × 7.7 cm mass in segment VII of his liver (Fig. 1). Needle biopsy confirmed the suspicion of hepatocellular carcinoma. Given his advanced stage of the disease with poor hepatic reserve, a minimally invasive ablative technique, laparoscopic RFA, was chosen to control tumor growth. His medical history was remarkable for hypertension, cholelithiasis,
Discussion
When acute hyperkalemia develops intraoperatively, several contributing factors should be considered [3]: 1) administration of a K+-containing solutions, 2) impaired renal K+ excretion, 3) pseudo-hyperkalemia, or 4) increased release of K+ from cells due to drugs or other factors. In this patient, the first two causes were dismissed since K+-containing solutions had not been given, urinary output was normal, and no elevation in serum BUN or creatinine occurred perioperatively. Although
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