TITLE:
Barbiturate Coma: Rebound and Refractory Hyperkalemia
AUTHORS:
Bonnie C. Greenwood, Christopher D. Adams, Zain I. Khalpey, Peter C. Hou
KEYWORDS:
Barbiturate, Rebound, Refractory Hyperkalemia
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.5,
May
16,
2014
ABSTRACT:
Purpose:
To describe a traumatic brain injury patient who experienced profound dyskalemia
upon the initiation and cessation of a pentobarbital infusion and propose management
options for future patients receiving this intervention. Methods: Case report. Results:
Case report. Conclusions: Dyskalemia has become an anticipated side effect of high
dose barbiturate infusions in the setting of elevated intracranial pressure. Hypokalemia
during the administration of a barbiturate infusion has been identified within this
patient population and was an expected adverse event during this intervention. However,
in this case we observed a significant and complicated refractory hyperkalemia
upon cessation of the barbiturate infusion which required aggressive management.
An objective causality assessment suggests that this adverse event was possibly
related to pentobarbital. What this case documents that other cases have not is
that upon re-introduction of the pentobarbital infusion, serum potassium levels
did not normalize. This questions whether severe rebound hyperkalemia is a pharmacodynamic
or infusion-related reaction. More data is needed to identify the mechanism of this
adverse event and recommend an appropriate treatment approach.