Hypothermia-induced hypokalemia.

Hypothermia may be seen both as a presenting problem and as a part of therapeutic strategy. An illustrative case is presented. In our case of severe head trauma, hypothermia was used as a therapeutic modality to minimize the brain injury. While hypothermic, the patient developed severe hypokalemia and was supplemented with 400 mEq of potassium. Upon rewarming, severe hyperkalemia occurred with resultant fatal arrhythmias. Severe hypokalemia may be seen in hypothermic patients, which represents a shift of potassium rather than a true loss. Careful management of this electrolyte problem must be given to avoid hyperkalemia with rewarming.