The Effect of Pre-Incision Urethral Plate Width and Granular Width on the Outcome of Tabularized Incised Urethral Plate Repair Surgery in Distal Penile Hypospadias, A Prospective Study

Hyperkalemia is a potentially lethal electrolyte disorder, encountered by nephrologists and intensivists in emergency department. Symptoms of hyperkalemia are often nonspecific and can ocassionally lead to life threatening cardiac arrhythmia. Here, we report the case of an 86 years old diabetic female who presented with acute kidney injury and severe hyperkalemia with serum potassium (9.3 mg/dl) that was out of proportion to fall in estimated glomerular filtration rate (23.5 ml/min/1.73m2 ). Additional analyses revealed high anion gap metabolic acidosis. The electrocardiogram showed sine-wave pattern of severe hyperkalemia. Echocardiography showed ischemic dilated cardiomyopathy with left ventricular ejection fraction 30%. The electrocardiogram did not normalize with the conservative medical treatment. Hemodialysis was initiated immediately and patient developed ventricular tachycardia during hemodialysis but patient was resuscitated successfully.

Keywords: Acute kidney injury; Elderly; Diabetes mellitus; Hyperkalemia; High anion gap acidosis