Fatal hyperkalemia during rapid and massive blood transfusion in a child undergoing hip surgery - A case report

Ming Hwang Shyr*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

27 Scopus citations

Abstract

We report a girl who developed severe and fatal hyperkalemia following rapid and massive blood transfusion during surgery. She was 7-year-old, 20-kg in weight, and received wide resection of the femoral bone with custom prosthesis implant because of malignant femoral ostcosarcoma. During the procedure, bleeding was active and profuse and amounted to about 3,000 mL in 4 h, eventuating in shock. Despite rapid transfusion with 15 units of packed red blood cells (RBC) still she remained hypotensive and hypovolemic. When we switched to give her whole blood, actually 100 mL having been given, widening of QRS complex followed immediately by cardiac arrest developed. Cardiopulmonary resuscitation although started at once was unsuccessful. At this juncture, arterial blood gas analysis showed acidosis and severe hyperkalemia (10.3 mmol/L), possibly resulting from transfusion of blood of older storage. The case reminded us once again the importance and necessity of the use of potassium-low blood component (fresh, saline-washed RBCs) in case of massive and rapid blood transfusion especially in pediatrie patients with hypovolemia and low cardiac output.

Original languageEnglish
Pages (from-to)163-166
Number of pages4
JournalMa zui xue za zhi = Anaesthesiologica Sinica
Volume37
Issue number3
StatePublished - 1999
Externally publishedYes

Keywords

  • Blood transfusion
  • Cardiac arrest
  • Shock

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