Hyperkalemia. A prognostic factor during acute severe hypothermia
M. D. Schaller, A. P. Fischer and C. H. Perret
Department of Medicine, University Hospital, Lausanne, Switzerland.
When hypothermic patients appear to be dead, the decision to resuscitate
may be difficult due to lack of reliable criteria of death. To discover
useful prognostic indicators, we reviewed the hospital charts of nine
hypothermic victims of snow avalanches (group A: median value of rectal
temperature, 29.6 degrees C; range, less than 12 degrees C to 34 degrees C)
and of 15 patients with hypothermia following acute drug intoxication
and/or cold exposure (group B: 28.8 degrees C; range, 25.5 degrees C to 32
degrees C. In group A, plasma potassium level on admission was extremely
high (14.5 mmol/L; range, 6.8 to 24.5 mmol/L) compared with that obtained
in group B (3.5 mmol/L; range, 2.7 to 5.3 mmol/L). All patients in group A
were in cardiorespiratory arrest. None could be successfully resuscitated
despite effective rewarming by cardiopulmonary bypass or peritoneal lavage.
In contrast, all of the patients in group B recovered from hypothermia,
including two in cardiorespiratory arrest. Thus, extreme hyperkalemia
during acute hypothermia appears to be a reliable marker of death. It might
be used to select those patients in whom heroic resuscitation efforts can
be useful.
