Despite the adequate fructosamine level, a 24-h blood glucose curve performed 2 days after his pre-operative blood work showed a blood glucose range of 21–36 mmol/L. His fructosamine level was normal (333 umol/L reference interval 136–350 umol/L) which indicated good diabetic regulation (<360 umol/L). His platelet count was normal ( Table 1). Pre-operative blood work performed 3 weeks prior to his cataract surgery with his primary care veterinarian was submitted to an external laboratory 1 and revealed mild hypoalbuminemia, elevated alkaline phosphatase, hyperglycemia, hyponatremia, mild hyperkalemia, and hypercholesterolemia ( Table 1). Other causes of this mild, intermittent hyperkalemia had previously been ruled out through extensive diagnostic testing, including an abdominal ultrasound, thoracic and abdominal computerized tomography, as well as endocrine testing (resting cortisol levels, adrenocorticotropic hormone stimulation tests, and serum lead levels). He had a history of mild, intermittent hyperkalemia (5.6–5.9 mmol/L) that was suspected to be pseudohyperkalemia secondary to thrombocytosis. The patient had an extensive medical history of the following: historical facial trauma resulting in right-sided facial nerve paralysis and right-sided lagophthalmos, inflammatory bowel disease, diabetes mellitus with episodes of diabetic ketoacidosis, bilateral cranial cruciate ligament rupture with bilateral tibial plateau leveling osteotomies, recurrent urinary tract infections, an acute intervertebral disc extrusion necessitating a C6–C7 ventral slot surgery, and a splenectomy for a splenic mass with histopathology confirming extramedullary hematopoiesis. Veterinary professionals should be aware that hyperkalemia can develop intra-operatively and remains be an important differential diagnosis in bradycardic patients under anesthesia that are not responding to traditional therapies.Īn 11-year-old, 49.9 kg, male neutered Rottweiler was presented to the Ophthalmology Service of Cornell University Veterinary Specialists (CUVS) for an elective bilateral phacoemulsification of diabetes mellitus-induced cataracts. However, numerous other diseases and medications can also lead to peri-operative hyperkalemia. New or unique information provided: Considering that there is a relationship between the development of severe hyperkalemia and propofol administration in human patients, it is possible that such a relationship exists in veterinary patients. The patient was discharged from the hospital without further complications and post-operative rechecks showed persistently normal serum potassium levels.

The patient responded to standard therapy for hyperkalemia on both occasions and serum potassium levels returned to normal. No underlying cause of hyperkalemia was definitively identified. The patient showed ECG changes consistent with hyperkalemia during the first anesthetic event, but not the second. The patient received similar drug protocols in both instances, including propofol, midazolam, non-depolarizing neuromuscular blocking agents, and isoflurane inhalant anesthetic. The definitive underlying cause of the hyperkalemia remains unknown.Ĭase summary: A 11 year-old male neutered Rottweiler underwent general anesthesia on two separate occasions at two different hospitals for ophthalmic surgery within a month and developed marked hyperkalemia on each occasion. Objective: To describe the development of recurrent hyperkalemia in a dog that underwent general anesthesia at two different hospitals within a month.

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