PMID- 24259739
OWN - NLM
STAT- MEDLINE
DCOM- 20140708
LR  - 20131122
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 47
IP  - 9
DP  - 2013 Sep
TI  - Heparin-induced hyperkalemia in a patient diagnosed with thyroid storm.
PG  - 1213-7
LID - 10.1177/1060028013503130 [doi]
AB  - OBJECTIVE: To describe a case of heparin-induced hyperkalemia and the role for 
      transtubular potassium gradient (TTKG) to guide fludrocortisone therapy. CASE 
      SUMMARY: A 52-year-old white male developed hyperkalemia after receiving 
      intravenous unfractionated heparin (UFH) for atrial fibrillation during thyroid 
      storm. Admission laboratory results were noteworthy for normal potassium levels, 
      undetectable thyroid-stimulating hormone, and mild transaminitis. Treatment for 
      thyroid storm was initiated but UFH was stopped because the international 
      normalized ratio was subsequently found to be elevated. Rising potassium levels 
      developed just 24 hours after UFH discontinuation, without exogenous potassium 
      supplementation, renal dysfunction, or acidosis. A TTKG was low, reflecting a 
      hypoaldosterone state. In addition, the Naranjo probability scale indicated 
      probable medication-associated hyperkalemia. Heparin-induced hyperkalemia (HIH) 
      was suspected and oral fludrocortisone 0.2 mg was given daily alongside serial 
      TTKG measurements. TTKG and hyperkalemia normalized with 2 days of treatment. 
      DISCUSSION: UFH is commonly used; therefore, clinicians must be cautious of 
      hyperkalemia. Although HIH usually resolves after discontinuation of heparin, it 
      may persist despite discontinuation of the drug, as highlighted by this case. In 
      this setting, a TTKG should be determined, which can be used to guide 
      fludrocortisone therapy. CONCLUSIONS: HIH can occur despite discontinuation of 
      heparin, and TTKG can be helpful in guiding fludrocortisone treatment in this 
      circumstance.
FAU - Cho, Roy
AU  - Cho R
AD  - Hennepin County Medical Center, Division of Pulmonary and Critical Care, 
      Minneapolis, MN.
FAU - Leclaire, Michele
AU  - Leclaire M
FAU - Kempainen, Robert
AU  - Kempainen R
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*adverse effects
MH  - Heparin/*adverse effects
MH  - Humans
MH  - Hyperkalemia/*chemically induced
MH  - Male
MH  - Middle Aged
MH  - Thyroid Crisis/drug therapy
OTO - NOTNLM
OT  - fludrocortisone
OT  - heparin-induced hyperkalemia
OT  - hyperkalemia
EDAT- 2013/11/22 06:00
MHDA- 2014/07/09 06:00
CRDT- 2013/11/22 06:00
PHST- 2013/11/22 06:00 [entrez]
PHST- 2013/11/22 06:00 [pubmed]
PHST- 2014/07/09 06:00 [medline]
AID - 47/9/1213 [pii]
AID - 10.1177/1060028013503130 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2013 Sep;47(9):1213-7. doi: 10.1177/1060028013503130.