TYK370

6 month-old, 8 kg female with sagittal craniosynostosis is presenting for repair. During intraoperative management, the patient is given 20 mL/kg of packed red blood cells for intraoperative blood loss repletion. An ABG demonstrates a pH of 7.21. There is an elevation of T-wave amplitude noted on the EKG. What would the BEST intervention to return the EKG to normal in this setting?

a) Administer Glucose

b) Administer Calcium Gluconate

c) Hyperventilate

d) Administer Insulin

e) Administer Sodium bicarbonate

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Answer

Answer b. This patient has just received a blood transfusion, which is a risk factor for hyperkalemia. The EKG finding of enlarging T-waves is an early sign of hyperkalemia. All of the possible answer choices are appropriate measures to address the elevated serum potassium value, but only one of hyperkalemia, but only administration of calcium is believed to stabilize cardiac membranes and decrease the risk of lethal dysrhythmia.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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