Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2019; 7(22): 3711-3717
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3711
Relationship between acute hypercarbia and hyperkalaemia during surgery
Laurence Weinberg, Amelia Russell, Lois Mackley, Charles Dunnachie, Joshua Meyerov, Chong Tan, Michael Li, Raymond Hu, Dharshi Karalapillai
Laurence Weinberg, Charles Dunnachie, Chong Tan, Michael Li, Raymond Hu, Department of Anaesthesia, Austin Health, Melbourne, Victoria 3084, Australia
Amelia Russell, Lois Mackley, Dharshi Karalapillai, Department of Intensive Care, Austin Health, Melbourne, Victoria 3084, Australia
Joshua Meyerov, Melbourne Medical School, University of Melbourne, Victoria 3010, Australia
Author contributions: Weinberg L planned and coordinated the study; Russell A, Mackley L, Dunnachie C and Meyerov J performed the literature review; Russell A, Mackley L, Dunnachie C, Meyerov J, Tan C, Hu R and Karalapillai D performed data collection; Weinberg L, Tan C and Karalapillai D analysed the data; Weinberg L, Russell A, Mackley L, Dunnachie C, Meyerov J, Tan C, Li M and Karalapillai D wrote the manuscript.
Supported by An internal Research Grant from the Department of Anaesthesia.
Institutional review board statement: The above project amendment has received ethical approval from the Austin Health Human Research Ethics Committee (HREC). This HREC is organised and operates in accordance with the National Health and Medical Research Council’s (NHRMC) National Statement on Ethical Conduct in Research Involving Humans (2007), and all subsequent updates, and in accordance with the Note for Guidance on Good Clinical Practice (CPMP/ICH/135/95), the Health Privacy Principles described in the Health Records Act 2001 (Vic) and Section 95A of the Privacy Act 1988 (and subsequent Guidelines).
Informed consent statement: All participants involved in this study provided written, informed consent prior to inclusion.
Conflict-of-interest statement: No conflicts of interest disclosed by the authors.
Data sharing statement: No additional data available.
STROBE statement: The authors have read the STROBE statement - checklist of items, and the manuscript was both written and revised according to the STROBE statement checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Laurence Weinberg, BSc, MBBCh, MRCP, FANZCA, DipCritCareEcho, MD, Associate Professor, Director, Department of Anaesthesia, Austin Health, 145 Studley Road, Melbourne, Victoria 3084, Australia. laurence.weinberg@austin.org.au
Telephone: +61-3-94965000 Fax: +61-3-94965000
Received: May 29, 2019
Peer-review started: June 4, 2019
First decision: August 1, 2019
Revised: August 30, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: November 26, 2019
Processing time: 181 Days and 19.7 Hours
Abstract
BACKGROUND

The relationship between hyperkalaemia and metabolic acidosis is well described in the critical care setting; however, the relationship between acute respiratory acidosis and plasma potassium concentration is less well understood. In a controlled model of increasing levels of hypercarbia, we tested the hypothesis of whether increasing levels of hypercarbia are associated with changes in plasma potassium concentrations.

AIM

To determine whether increasing levels of hypercarbia are associated with changes in plasma potassium concentrations.

METHODS

We performed a post-hoc study examining changes in serum potassium in 24 patients who received increased levels of hypercarbia during cardiac surgery. Arterial blood gases and plasma concentrations of potassium were measured at baseline, 3 min prior to, and then every 3 min for 15 min during the intervention of hypercarbia. The primary endpoint was the absolute change in serum K+ at 15 min compared to the baseline K+ value. The following secondary endpoints were evaluated: (1) The association between CO2 and serum K+ concentration; and (2) The correlation between plasma pH and serum K+ concentrations.

RESULTS

During the intervention, PaCO2 increased from 43.6 mmHg (95%CI: 40.1 to 47.1) at pre-intervention to 83.9 mmHg (95%CI: 78.0 to 89.8) at 15 min after intervention; P < 0.0001. The mean (SD) serum potassium increased from 4.16 (0.35) mmol/L at baseline to 4.28 (0.33) mmol/L at 15 min (effect size 0.09 mol/L; P = 0.22). There was no significant correlation between PaCO2 and potassium (Pearson’s coefficient 0.06; 95%CI: -0.09 to 0.21) or between pH and potassium (Pearson’s coefficient -0.07; 95%CI: -0.22 to 0.09).

CONCLUSION

Acute hypercarbia and subsequent respiratory acidaemia were not associated with hyperkalaemia in patients undergoing major surgery.

Keywords: Anaesthesia; Intensive care; Biochemistry; Surgery

Core tip: Acute hypercarbia results in respiratory acidosis and subsequent respiratory acidaemia. Acute hypercarbia does not affect serum potassium concentrations in the setting of anaesthesia and major surgery. Respiratory acidaemia does not affect serum potassium concentrations in patients undergoing major surgery.