Case report
Life-threatening hyperkalemia during radiofrequency ablation of hepatocellular carcinoma

https://doi.org/10.1016/j.jclinane.2009.08.008Get rights and content

Abstract

A 48 year-old man with hepatitis C and cirrhosis was admitted for laparoscopic radiofrequency ablation of a large hepatocellular carcinoma. The patient's renal function tests and serum potassium level were all within normal limits. About 120 minutes into the procedure, the patient developed sudden, wide-complex tachycardia. Initial blood tests showed serum and plasma potassium level of 7 mEq/L, but no other abnormalities. The thermal destruction of large tumors during radiofrequency ablation may be associated with extensive cell breakdown and transcellular shift of potassium.

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

References (14)

There are more references available in the full text version of this article.
View full text
Published by Elsevier Inc.