Abstract: FR-PO0895
Dialyzing Before Declamping: Preventing Reperfusion Hyperkalemia with Intraoperative CRRT
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 1
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Yousuf, Ali K., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Sutzko, Danielle Christine, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Tolwani, Ashita J., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Patel, Devansh H., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
Introduction
Total aortic occlusion is a rare but catastrophic vascular emergency associated with profound ischemia and high mortality. Reperfusion during surgical declotting can precipitate severe hyperkalemia placing patients at significant risk for intraoperative cardiac arrest. While the utilization of extracorporal potassium removal in these situations has been proposed; strategies to mitigate this risk are not well established.
Case Description
We report the case of a 77 year old woman with a history of congestive heart failure, atrial fibrillation, chronic kidney disease, hypertension, type 2 diabetes, and coronary artery disease who was transferred to our medical center with acute total aortic occlusion. The patient reported original symptom onset around 1 week prior to presentation. The patient presented with oliguric AKI; with a serum creatinine of 2.5 mg/dL and urine output of 5 to 10 cc/hr. Due to the anticipated high potassium burden from her prolonged ischemia, the multidisciplinary team involved in her care elected to initiate intraoperative continuous renal replacement therapy (CRRT) during the extended surgery for primary prophylactic treatment of intraoperative hyperkalemia. Dialysis access was obtained by the anesthesia team once the patient presented to the operating room and CRRT was initiated utilizing continuous veno-venus haemo-diafiltration (CVVHDF) at a target dose of 28.5 ml/kg/hr and utilization of with a potassium concentration of 4 mmol/L. During her operative reperfusion, the serum potassium levels were effectively controlled. Her serum potassium ranged from 4.0 to 3.6 mMol/L throughout the 5 hour reperfusion surgery. The patient remained hemodynamically stable throughout the procedure. Creatine Kinase post reperfusion peaked at 3378 Units/L Postoperatively, the patient required ongoing CRRT with a dose reduction to 20 ml/kg/hr for anuric acute kidney injury; however did successfully develop renal recovery after 5 days of CRRT and no longer required renal replacement therapy.
Discussion
This case highlights the potential utilization of intraoperative CRRT as a preventative strategy to mitigate reperfusion associated hyperkalemia in the setting of extensive ischemic burden. While not without its own risks and increased complexity of intraoperative delivery, CRRT may help to reduce the risk of fatal arrhythmias by facilitating controlled electrolyte clearance during declamping.