Hyperkalemia in the perioperative patient: common etiologies and initial management?

• A. Renal failure, rhabdomyolysis, massive tissue injury
• B. Arrhythmias due to hyperkalemia
• C. Hypokalemia is a common cause
• D. Sodium bicarbonate therapy

Answer: (A)

Hyperkalemia in the perioperative setting is most often driven by two main factors: reduced potassium excretion by the kidneys and release of potassium from damaged or rapidly turning-over tissue. Renal failure limits potassium clearance, rhabdomyolysis dumps intracellular potassium into the bloodstream, and massive tissue injury from surgery or trauma can also release potassium. These etiologies explain why those three factors are commonly responsible for elevated potassium around operative events. Other choices describe what hyperkalemia can cause or how you treat it, not why it occurs: arrhythmias are a dangerous consequence, hypokalemia is the opposite condition, and sodium bicarbonate is a treatment used after hyperkalemia is established rather than an underlying cause. For initial management, act quickly: stabilize the heart with IV calcium if ECG changes are present, shift potassium into cells with insulin plus glucose and, if available, a beta-agonist, and consider bicarbonate if acidosis is present. Then remove potassium from the body with diuretics if kidney function allows, potassium-binding resins, or urgent dialysis in severe cases, all while addressing the underlying cause such as ongoing tissue injury or rhabdomyolysis.