Coma Research Today is a free monthly online journal that collates and summarizes the latest research about Coma, including details on causes, diabetes, gcs, recovery.

Hypokalaemia with severe rebound hyperkalaemia after therapeutic barbiturate coma.

Neil MJ, Dale MC

Department of Anaesthesia and Critical Care, Ninewells Hospital, Dundee, Scotland, DD2 9SY. mneil@nhs.net

Severe disturbance of potassium balance is a rare but life-threatening complication of therapeutic barbiturate coma. A 14-yr-old patient was treated with a thiopental infusion for management of increased intracranial pressure after severe head injury. The patient had persistent hypokalaemia during the thiopental infusion. On cessation of the infusion the patient rapidly developed a tachydysrhythmia associated with a serum K+ of 7.0. Possible mechanisms of this phenomenon are discussed. We conclude that aggressive treatment of hypokalaemia during barbiturate coma should be avoided, and advocate a tapering dose of thiopental and not abrupt cessation of an infusion. Severe disturbance of plasma potassium balance is a rare but life-threatening complication of therapeutic barbiturate coma. Awareness of this complication should be raised and management altered to less aggressive treatment of hypokalaemia occurring during thiopental infusion, with a tapering dose used on discontinuation to limit a rebound phenomenon.

Published 18 May 2009 in Anesth Analg, 108(6): 1867-8.
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