[utahliz]

I had a direct-return open-heart last night. Returned on dobutamine and Levo, weaned the Levo off almost immediately. Treated a marginally-low K, around 3.9 I think, with 20 mEq per orders. Gave a boatload of blood products for an apparent clotting disorder-- 4 units PRBC's, 4 units FFP, cryoprecipitate, 6 pk platelets, plus protamine, and started an insulin gtt for elevated blood sugar. On the follow-up check of labs, K was up to 5.1. Pt. had great urine output. The K should have been down, not up. Colleagues didn't have any ideas. Normal Na level made me think that it wasn't an adrenal issue. All I could come up with was that there was a hemolytic process going on somewhere. Other than the bleeding issues, hemodynamics were steady with good numbers, she looked good, neuros intact. Any thoughts on this?

[Jolie]

My guess would be that some of the transfused PRBCs were hemolyzed, either by the process of transfusion, or by the patient's body upon receiving them. Even when properly typed and X-matched, transfused blood products are still a foreign tissue and are subject to some degree of rejection by the recipient, resulting in breakdown of a portion of the transfused PRBCs.

[cardiacRN2006]

I believe the K conc of stored blood is around 5.5 -6. So large administration is something I'm always aware of while giving blood. If we give more than a few units, we always are weary of the K level...

[RN1980]

i think all of you are correct, there is some type of systemic inflammatory response by your body from the transfussion itself that may cause some cell lysis/breakdown, and some k+ will ooze out of the prbc's in storage. good for you to be "johnnie on the spot" with picking up the increase in k+.

[utahliz]

Thanks for the thoughts. I should have added that the pt. was not acidotic, either. Well, I'll have to keep an eye out for this in the future and see if it occurs again. Love the mysteries that make us think hard and put our heads together!

[nurseabc123]

Originally Posted by utahliz

I had a direct-return open-heart last night. Returned on dobutamine and Levo, weaned the Levo off almost immediately. Treated a marginally-low K, around 3.9 I think, with 20 mEq per orders. Gave a boatload of blood products for an apparent clotting disorder-- 4 units PRBC's, 4 units FFP, cryoprecipitate, 6 pk platelets, plus protamine, and started an insulin gtt for elevated blood sugar. On the follow-up check of labs, K was up to 5.1. Pt. had great urine output. The K should have been down, not up. Colleagues didn't have any ideas. Normal Na level made me think that it wasn't an adrenal issue. All I could come up with was that there was a hemolytic process going on somewhere. Other than the bleeding issues, hemodynamics were steady with good numbers, she looked good, neuros intact. Any thoughts on this?

The range of K in PRBCs can range from 5.4 to 18.4 mEq/L depending on how fresh it is. The older the packed cells, the more K.

[NoviceToExpert]

Originally Posted by nurseabc123

The range of K in PRBCs can range from 5.4 to 18.4 mEq/L depending on how fresh it is. The older the packed cells, the more K.

Exactly what I was thinking... the closer the blood is to the expiration date, the higher the K+ content...

[globalRN]

correct, the older the bag of prbc the more K+ from hemolyzed old red cells....as the cells hemolyze
they release cell contents...which have a high k+ content

I take into account that tx prbc is like a iv shot of k+