cardioplegia leak??

[WSU_Ally_RN, BSN, RN]

Hi my allnurses friends :)

I admitted a stable, extubated post op ASD repair yesterday afternoon. Pt's first K level was 3.1. Over the course of 5 hours it rose to 5.9 with no extra potassium being given except the 20 meq that was in the liter of her IVF. When the pt's K hit 4.7 we changed the fluids and took the potassium out, but it still increased. Of course the pt hit 5.9 around shift change... The NP ordered a dose of lasix while they investigated this further.

Apparently the pt did well overnight after that dose of lasix was given, but early in the am the pt's K levels were slowly starting to climb again. The attending that was on decided that the pt had a cardioplegia leak, which I have no idea what he meant. The NP that relayed this to me also didn't know what the attending meant. I have tried to google "cardioplegia leak after CPB" and I get no answers... anyone ever heard of this or know what my attending might have meant??

Thanks for any insight or help you can give :)

[missnurse01, MSN, RN]

Hi my allnurses friends :)

I admitted a stable, extubated post op ASD repair yesterday afternoon. Pt's first K level was 3.1. Over the course of 5 hours it rose to 5.9 with no extra potassium being given except the 20 meq that was in the liter of her IVF. When the pt's K hit 4.7 we changed the fluids and took the potassium out, but it still increased. Of course the pt hit 5.9 around shift change... The NP ordered a dose of lasix while they investigated this further.

Apparently the pt did well overnight after that dose of lasix was given, but early in the am the pt's K levels were slowly starting to climb again. The attending that was on decided that the pt had a cardioplegia leak, which I have no idea what he meant. The NP that relayed this to me also didn't know what the attending meant. I have tried to google "cardioplegia leak after CPB" and I get no answers... anyone ever heard of this or know what my attending might have meant??

Thanks for any insight or help you can give :)

well I don't do peds but do adult OHS and I haven't ever seen this. I assume it would take a lot less volume in the peds area to affect the K then in the adult population though! Somehow the bath that they use for the cardioplegia which has K in it has someone either not been rinsed and suctioned out well, and/or it is reabsorbing into the vasculature. I don't think that there is anything you can do until it is finished leveling off to prevent it from going up again, just treat as it gets higher.

will be interesting to see what others have to say!

[WSU_Ally_RN, BSN, RN]

The funny thing is, this particular pt was an adult! They were in their 20's and never had the ASD closed as a kid... Thats kind of what I was thinking too, but not finding any literature or articles on it I wasn't so sure...

[missnurse01, MSN, RN]

was asking around at work tonight and we are all dumbfounded. I am assuming that the normal causes of high potassium were not evident in this guy (low u/o, poor renal fx, etc)...

[missnurse01, MSN, RN]

ok. Spoke with a nurse with over 30 years of experience, working 6-7 nights a week nearly the entire time.

She said yes she has seen it, and it can def happen. Somewhere along the line they ended up absorbing some. She said at least for the first 12-24 hrs or so you can see that increase, and it sounds like from your scenario it is def within that time frame.

will ask a doc if I ever see one (night shift)!