Awad Mark, Bonitz Joyce, Pratt Abimbola
Department of Surgery, Hackensack Meridian Jersey Shore University Medical Center, 1945 NJ-33, Neptune City, NJ, 07753, United States.
Department of Surgery, Hackensack Meridian Jersey Shore University Medical Center, 1945 NJ-33, Neptune City, NJ, 07753, United States.
Int J Surg Case Rep. 2020;71:323-326. doi: 10.1016/j.ijscr.2020.05.032. Epub 2020 May 29.
Intracranial hypertension that is not responsive to other therapies can be managed through the use of a barbiturate induced coma. Although potentially effective, there are known complications associated with this treatment, and as such it is typically reserved for the most severe cases. One such sequela of barbiturate induced coma therapy is refractory hypokalemia and subsequent rebound hyperkalemia.
This case report discusses a patient who experienced hypokalemia during pentobarbital induced coma for unmanageable elevations in intracranial pressure and was treated conservatively to avoid rebound hyperkalemia depicting successful deployment of permissive hypokalemia.
It is vital that clinicians understand the possible adverse effects associated with barbiturate induced coma therapy, and that a careful balance be struck between hypokalemia and potassium supplementation to avoid rebound hyperkalemia.
Given that the risk of rebound hyperkalemia is of significant concern in patients who experience hypokalemia on barbiturate induced coma therapy, permissive hypokalemia can be a viable treatment option achieved by lowering the potassium replacement target threshold in such patients.
对其他治疗无反应的颅内高压可通过使用巴比妥类药物诱导昏迷来处理。尽管这种治疗可能有效，但已知存在与此治疗相关的并发症，因此通常仅用于最严重的病例。巴比妥类药物诱导昏迷治疗的一个后遗症是难治性低钾血症及随后的反弹性高钾血症。
本病例报告讨论了一名患者，该患者在因颅内压难以控制的升高而接受戊巴比妥诱导昏迷期间出现低钾血症，并接受了保守治疗以避免反弹性高钾血症，描述了允许性低钾血症的成功应用。
临床医生必须了解与巴比妥类药物诱导昏迷治疗相关的可能不良反应，并且在低钾血症和补钾之间要谨慎权衡以避免反弹性高钾血症。
鉴于在巴比妥类药物诱导昏迷治疗中出现低钾血症的患者，反弹性高钾血症的风险备受关注，允许性低钾血症可以是一种可行的治疗选择，通过降低此类患者的补钾目标阈值来实现。
