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Intra‐operative hyperkalemia: a serious but under recognised complication of renal parathyroidectomy – a prospective study: how we do it

Dear Editor, Approximately 29% of patients with long-term chronic renal failure (CRF) undergo parathyroidectomy to control secondary hyperparathyroidism that occurs as a result of chronic parathyroid stimulation caused by failure of adequate Vitamin D synthesis. Patients with renal failure have associated metabolic complications and electrolyte disturbance. The senior authors (RJE, SR) in this study were involved with a 20year-old patient with renal failure undergoing total parathyroidectomy, who had a cardiac arrest intra-operatively. Despite aggressive resuscitation, the patient died. At the commencement of the resistant ventricular fibrillation arrest, the patient’s serum potassium level had risen from 3.3 mm at induction to 7.8 mm over 1 h. After such a devastating complication, potassium levels were subsequently monitored in these patients during the operation. On reviewing the literature, there is no mention of this intraoperative complication during renal parathyroidectomy. Hyperkalemia is recognised as a complication within the first 24 h post-operatively after parathyroidectomy. This study is a prospective analysis of intra-operative monitoring of potassium levels for patients with CRF undergoing parathyroidectomy under the care of the senior author (RJE).