[Case of unexpected intraoperative hyperkalemia].

We experienced a case of unexpected ECG abnormality with hyperkalemia. A 65-year-old man was suffering from maxillary sinus cyst and Caldwell-Luc procedure was scheduled. He had diabetes mellitus and hypertension for 15 years, and was taking oral hypoglycemic agent and hypotensive drug (angiotensin converting enzyme and angiotensin receptor blockers : ARB). Abnormal findings were HbA1c 7.7% and glycosuria over 1,000 mg x dl(-1). ECG and other laboratory tests were within normal limits. The patient was monitored with 3 leads ECG during the operation. At one hour and 33 minutes after the start of operation, we detected sudden ECG changes consisting of wide QRS wave and peaked T wave. We consider hyperkalemia and checked blood potassium concentration three times. The results were 5.8, 6.3, 6.2 mmol x l(-1), respectively. We treated the patient with calcium gluconate injection, saline infusion, furosemide injection and glucose-insulin therapy. The ECG was normalized one hour and 23 minutes after the abnormal ECG finding and the potassium concentration decreased to 4.8 mmol x min(-1). After the operation, the potassium concentration and creatinine clearance were within normal limits. Hyperkalemia in this case might have been induced by diabetes mellitus, administration of ACEI and ARB, and hypovolemia.