Key result
Therapeutic hypothermia triggers hypokalemia in ~60% of patients, with potassium closely tracking temperature during rewarming.
Why the study?
Hypokalemia commonly occurs during therapeutic hypothermia and is managed with potassium administration, but the underlying mechanisms and dynamics during rewarming required investigation.
How does induced therapeutic hypothermia and subsequent rewarming affect serum potassium levels in comatose survivors of cardiac arrest?
Observational (n=74)
No
How does induced therapeutic hypothermia and subsequent rewarming affect serum potassium levels in comatose survivors of cardiac arrest?
Serum potassium correlates strongly with body temperature during therapeutic hypothermia and rewarming, indicating that potassium replacement during cooling should be cautious and avoided during rewarming to prevent fatal rebound hyperkalemia.
Answers are grounded in this paper and cite their sources.
May warrant cautious potassium repletion during cooling; leaves open optimal protocols pending prospective trials.
Introduction Hypokalemia is known to occur in association with therapeutically induced hypothermia and is usually managed by the administration of potassium (K+). Methods We reviewed data from 74 patients who underwent a therapeutic hypothermia protocol at our medical institution. Results In four patients in whom data on serum K+ and temperature were available, a strong positive correlation between serum K+ and body temperature was found. Based on the close positive relationship between serum K+ and total body temperature, we hypothesize that serum K+ decreases during hypothermia owing to decreased activity of temperature-dependent K+ exit channels that under normal conditions are sufficiently active to match cellular K+ intake via sodium/K+/adenosine triphosphatase. Upon rewarming, reactivation of these channels results in a rapid increase in serum K+ as a result of K+ exit down its concentration gradient. Conclusion Administration of K+ during hypothermia should be done cautiously and avoided during rewarming to avoid potentially life-threatening hyperkalemia. K+ exit via temperature-dependent K+ channels provides a logical explanation for the rebound hyperkalemia. K+ exit channels may play a bigger role than previously appreciated in the regulation of serum K+ during normal and pathophysiological conditions.
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Boubes et al. (2022) conducted an observational in Comatose survivors of cardiac arrest undergoing induced therapeutic hypothermia (n=74). Induced therapeutic hypothermia and subsequent rewarming was evaluated on Correlation between serum potassium concentration and body temperature during hypothermia and rewarming, and incidence of hypokalemia (r = 0.878 to 0.945, p=<0.001 to 0.002). Induced therapeutic hypothermia led to hypokalemia in 59.5% of patients and showed a strong positive correlation between serum K+ and body temperature during rewarming (r = 0.878 to 0.945, P <= 0.002).
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