Abstract: TH-PO352
A 57-Year-Old Uremic Man with Recurrent Hyperkalemia following Parathyroidectomy
Session Information
- Sodium, Potassium, and Volume Disorders: Clinical
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Lu, Ang, Tri-Service General Hospital, Taipei, Taiwan, Taiwan
- Lin, Chin, National Defense Medical Center, Taipei, Taiwan, Taiwan
- Lin, Shih-Hua P., National Defense Medical Center, Taipei, Taiwan, Taiwan
Introduction
Hyperkalemia, associated with an increased mortality risk in hemodialysis (HD) patients, with a higher incidence during the post-parathyroidectomy period, can be divided into shifting causes and non-shifting causes. We present a case of recurrent hyperkalemia associated with severe hypocalcemia following parathyroidectomy rapidly recognized by artificial intelligence electrocardiography (AI-ECG).
Case Description
A 57-year-old uremic male on maintenance HD four times per week presented to the emergency department (ED) at night with muscle twitching and carpopedal spasm. His medication regimen was unchanged, and he had no prior hyperkalemia episode. One week earlier, he underwent parathyroidectomy with autograft implantation for severe secondary hyperparathyroidism, renal osteodystrophy, and pruritus unresponsive to phosphate binder, calcitriol, and calcimimetic. On the 8th postoperative day, he returned to the ED with palpitations and tetany. An AI-ECG alerted hyperkalemia predicting 7.25 mmol/L. Confirmed with hypocalcemia (ionized calcium 2.83 mg/dL) and hyperkalemia (6.7 mmol/L), the tetany resolved within 2 hours following calcium infusion and emergency HD. Despite oral calcium polystyrene sulfonate treatment, he returned to the ED on the 10th postoperative day with the same symptoms and received the same management, leading to symptom resolution.
Discussion
Despite being a known issue, hyperkalemia is often under-managed in HD patients, particularly following parathyroidectomy, where it primarily arises from potassium shifting. A preventive strategy of quantifying calcium supplement dosage postoperatively based on the estimated bone turnover rate is crucial. The risk of HD patients being vulnerable to potassium accumulation and redistribution can be mitigated by advanced AI technology. Increased vigilance and rapid treatment of hyperkalemia in this high-risk population are warranted.
The ECG and AI analysis model from 1st tenancy episode