Hyperkalemia combined with carbon monoxide poisoning, should hemodialysis or hyperbaric oxygen treatment be given first?: A CARE-compliant article.

RATIONALE

Hyperkalemia and acute carbon monoxide (CO) poisoning are both life-threatening conditions. When these conditions coexist, there is a debate on whether hemodialysis or hyperbaric oxygen (HBO) therapy should be prioritized. Our discussion suggests that HBO therapy may help by lowering residual carbon dioxide levels and correcting electrolyte imbalances, consequently decreasing the risks linked to both CO poisoning and hyperkalemia.

PATIENT CONCERNS

A 25-year-old man presented with hyperkalemia and CO poisoning. He was promptly taken to the emergency room where he received immediate interventions including intravenous infusion of 5% sodium bicarbonate solution, glucose plus insulin, diuretics, and calcium supplementation in a HBO environment. Subsequently, hemodialysis was performed. Following this treatment protocol, the patient showed significant improvements in hyperkalemia, CO levels, general weakness, cardiac arrhythmias, and other symptoms. This sequential therapy effectively eliminated the remaining CO in his system and addressed the electrolyte imbalances crucial to his recovery. After 4 weeks of comprehensive treatment, the patient's hyperkalemia and CO poisoning issues were successfully resolved.

DIAGNOSES

Based on the thorough history, electrocardiographs and the laboratory tests.

INTERVENTIONS

The interventions included intravenous infusion of 5% sodium bicarbonate solution, glucose plus insulin, diuretics, calcium supplementation in a HBO environment, and followed by hemodialysis.

OUTCOMES

The following clinical improvements were detected: consciousness was clear; the cardiac arrhythmia symptoms were improved (electrocardiograph became normal); normal electrolytes with no other abnormalities; displayed no nervous system symptoms.

LESSONS

Sequential treatment of intravenous fluid rehydration, HBO, hemodialysis may be effective in treating patients with hyperkalemia combined with CO poisoning.