Abstract: PUB008
Severe Postpartum Ischemic AKI with Life-Threatening Hyperkalemia and Cardiac Complications Successfully Managed Without Dialysis
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Mohamed, Muner, Ochsner Health, New Orleans, Louisiana, United States
- Mousay, Eyiman A., Tobruk Medical Center, Tobruk, Libya
- Mahjoub, Sari Sulayman Abdulhafith, Tobruk Medical Center, Tobruk, Libya
- Hasan, Hana A., Tobruk Medical Center, Tobruk, Libya
Introduction
Postpartum acute kidney injury (AKI) due to hemorrhagic shock can present with life-threatening metabolic and cardiac complications, often prompting urgent renal replacement therapy (RRT). Identifying patients who may safely recover with conservative management remains a key clinical challenge
Case Description
A 31-year-old woman developed oliguric AKI following postpartum hemorrhage, with a peak serum creatinine of 5.04 mg/dL. Her course was complicated by severe hyperkalemia (7.17 mEq/L) associated with sinus bradycardia and right bundle branch block, as well as a moderate pericardial effusion (~120 mL). Serum albumin declined to 2.7 g/dL during the acute phase. Despite meeting conventional indications for dialysis, a closely monitored conservative approach was pursued. Hyperkalemia was promptly stabilized with intravenous calcium gluconate followed by insulin–dextrose therapy, resulting in rapid normalization of potassium levels and resolution of conduction abnormalities within 48 hours. Intravascular volume was optimized, and low-dose diuretics led to improved urine output, followed by a marked polyuric phase (>5 L/day). Serial echocardiography demonstrated complete resolution of the pericardial effusion within five days. Kidney function fully recovered by day 11 (creatinine 1.1 mg/dL) without the need for RRT
Discussion
This case illustrates reversible cardiorenal instability in postpartum ischemic AKI, where severe hyperkalemia with electrocardiographic changes and pericardial effusion may mimic absolute indications for dialysis. However, rapid biochemical response, improving urine output, and evidence of preserved tubular function supported continued conservative management. In carefully selected patients, intensive monitoring and targeted medical therapy may allow safe avoidance of RRT. Early indicators of reversibility should guide individualized decision-making in similar high-risk presentations