Insulin/sodium bicarbonate
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Hypokalaemia and refractory asystole: case report A 23-year-old woman developed hypokalaemia and refractory asystole after receiving insulin and sodium bicarbonate. The woman presented to hospital with a 2-week history of polyuria, polydipsia, weight loss and a productive cough. Investigations established severe metabolic acidosis. She received 4 units IV bolus insulin followed by insulin infusion 4 units/h. She was intubated electively, and potassium chloride was started with 100mL of IV bolus sodium bicarbonate 8.4% to correct acidosis. About 2 hours later, she developed pulseless wide QRS complex ventricular tachycardia and CPR was initiated. She required direct current shock after developing ventricular fibrillation (VF); asystole occurred, lasting for 4 minutes, and a transcutaneous pacemaker was attached. CPR continued and she briefly regained a normal pulse but reverted back to VF, followed by asystole. Hypokalaemia was suspected and insulin was discontinued. Her stat potassium level was 1.7 mmol/L; she received an IV bolus of potassium chloride which immediately reversed her asystole. She returned to a normal sinus rhythm. No further doses of sodium bicarbonate were given. She was transferred to an ICU and, when her potassium level was satisfactory, IV insulin was switched to SC insulin. She was extubated 24 hours after her initial presentation. She recovered and was transferred to a general ward, where she remained for 2 days. Follow-up 2 weeks after discharge found her in a "normal" condition. Author comment: "In our patient, the initial potassium level was 3.6 mmol/L. Stat insulin therapy followed by a bolus of bicarbonate to elevate extracellular pH led to further dramatic fall in serum potassium culminating in ventricular tachycardia and refractory asystole." Abdulaziz S, et al. Hypokalaemia and refractory asystole complicating diabetic ketoacidosis, lessons for prevention. BMJ Case Reports : Jan 2012. Available 803085858 from: URL: http://dx.doi.org/10.1136/bcr-2012-007312 - Saudi Arabia
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Reactions 20 Apr 2013 No. 1448
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