Hyperkalemia secondary to iatrogenic overdose of intravenous dextrose supplementation in a diabetic dog undergoing anesthesia for phacoemulsification.

Abstract

A 13-year-old, male castrated, Jack Russell Terrier dog was presented for bilateral phacoemulsification for treatment of diabetic cataracts. While the dog was under general anesthesia, a blood glucose concentration of 3.8 mmol L(70 mg dL) was noted. The anesthesia technician was instructed to give 0.5 mL kgof 50% dextrose intravenously (IV) diluted 1:1 with saline as a slow bolus, but instead administered 5 mL kgof 50% dextrose IV. This resulted in a blood glucose concentration exceeding 41.7 mmol/L (750 mg dL; upper threshold of glucometer). The supervising anesthetist and ophthalmologist were notified and treatment provided with 0.13 U kgof regular insulin IV and a fluid bolus of Lactated Ringer's solution (5 mL kgover 10 minutes). At the end of the procedure, a cardiac arrhythmia was noted, with audible arterial pulse deficits appreciated on the ultrasound Doppler unit. Repeat blood sample analysis showed hyperkalemia of 6.8 mmol Land blood glucose concentration greater than 27.7 mmol L(500 mg dL, upper limit of biochemistry panel). Electrocardiogram (ECG) monitoring confirmed an underlying sinus rhythm with atrial bigeminy, which normalized upon improvement of hyperkalemia. The case was reviewed by team members and an incident report was submitted. Iatrogenic dextrose overdose can cause transient hyperkalemia due to intracellular potassium shifting to the extracellular compartment.