ArticleAnnals of medicine and surgery (2012)2026
Adrenaline-induced hypokalemia and critical QT prolongation in a patient with refractory anaphylactic shock complicated by myocardial ischemia: a case report.
Article in Annals of medicine and surgery (2012), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Adrenaline is the first-line treatment for anaphylactic shock. However, adrenaline administration may exacerbate myocardial ischemia and induce fatal arrhythmias. It can also cause hypokalemia, thereby increasing the risk of life-threatening cardiac events. Case presentation: A 58-year-old man developed refractory anaphylactic shock accompanied by electrocardiographic evidence of myocardial ischemia during spinal fusion surgery. A total of 3.6 mg of intravenous adrenaline was required. At 135 minutes after onset, the serum potassium level decreased to a nadir of 2.1 mmol/L, resulting in critical QT prolongation. Timely adrenaline discontinuation and potassium supplementation resolved the hypokalemia, resulting in a favorable outcome. Discussion: Adrenaline is known to induce hypokalemia through a rapid and severe intracellular potassium shift via β2-adrenergic stimulation; however, this effect may be underestimated. The synergistic interaction of myocardial ischemia during anaphylactic shock, the direct adverse effects of adrenaline on the myocardium, and adrenaline-induced hypokalemia significantly increases the risk of fatal arrhythmias. Conclusion: When using multiple and/or continuous doses of adrenaline, clinicians should consider proactive monitoring of potassium levels and potassium supplementation, thereby preventing life-threatening arrhythmias.
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