tailieunhanh - Báo cáo y học: "Cardiac arrest following a glucose 30% bolus: what happened"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Cardiac arrest following a glucose 30% bolus: what happened? | Available online http content 12 1 401 Letter Cardiac arrest following a glucose 30 bolus what happened Philippe Goutorbe1 Nadia Kenane1 Julien Bordes1 Christophe Jego2 Ambroise Montcriol1 and Eric Meaudre1 1HIA Ste Anne Daru Bd Ste Anne 83000 Toulon France 2HIA Ste Anne Cardiology Bd Ste Anne 83000 Toulon France Corresponding author Philippe Goutorbe Published 16 January 2008 This article is online at http content 12 1 401 2008 BioMed Central Ltd Critical Care 2008 12 401 doi cc6216 A 74-year-old man was admitted with postoperative peritonitis. On day 45 a double-lumen central venous catheter was positioned in the patient s right subclavian vein. The distal lumen was used only for parenteral nutrition 2 000 ml day Kabiven 1600 Fresenius Kabi Brezin France . Glucose 5 250 ml with 6 g potassium was infused over 24 hours via the proximal lumen. Hypokalemia was noted K mEq l . An additional infusion of potassium was initiated 34 mEq in 10 ml at 17 mEq hour via the proximal lumen. One hour later hypoglycemia was detected and 20 ml of 30 glucose was given intravenously. At the end of the injection ventricular fibrillation developed. Cardiopulmonary resuscitation successfully restored adequate circulation within 12 minutes. Blood analysis performed using an ABL 700 Radiometer Copenhagen Denmark 1 minute after beginning cardiac resuscitation showed serum potassium of mmol l ionised calcium of mmol l and serum sodium of 140 mmol l. The empty ampoule was checked and had contained the correct solution. The cardiac rhythm had been normal before the glucose bolus was given but sinus arrest with junctional or idioventricular escape rhythm developed at the end of bolus administration immediately followed by ventricular fibrillation Figure 1 . The patient was discharged 2 weeks later without any sequelae. Electrocardiographic changes are not usually seen until serum potassium exceeds mmol l. .