Key result
ESRD patient tolerates extreme serum potassium of 10.2 mmol/L with only mild EKG changes.
Why the study?
Dialysis patients typically tolerate high potassium levels, but reports of extreme hyperkalemia above 9 mmol/L usually occur with cardiac arrest.
Case Report (n=1)
Demonstrates that some chronic dialysis patients can tolerate extreme hyperkalemia (>9 mmol/L) without experiencing cardiac arrest due to chronic adaptation.
Extreme hyperkalemia may be tolerated in select ESRD patients; leaves open whether chronic adaptation alters management thresholds or risk models.
Dialysis patients are known to tolerate high potassium due to the chronic hyperkalemia that is inherent in their disease. Despite this, most reports of extremely high potassium (>9 mmol/L) are in the setting of cardiac arrest. We describe the case of a 57-year-old Caucasian male with past medical history significant for end stage renal disease known to be non-adherent to a low potassium diet as well as missed dialysis appointments.
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Attaway et al. (2015) conducted a case report in End stage renal disease with extreme hyperkalemia (n=1). Emergent hemodialysis was evaluated on Normalization of EKG and mental status. A 57-year-old male with end-stage renal disease tolerated an extreme serum potassium level of 10.2 mmol/L with only mild EKG changes, which normalized following emergent hemodialysis.
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