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      Labetalol-Induced Hyperkalemia in Renal Transplant Recipients

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          Abstract

          Background: Labetalol is a commonly used agent for perioperative hypertension in renal transplant recipients. A previous report suggested that labetalol may cause life-threatening hyperkalemia after renal transplantation. Methods: We performed a retrospective review of 103 consecutive renal transplants to determine whether labetalol was an independent predictor of hyperkalemia treatment. Thirty-eight patients (36.9%) received labetalol, and 65 patients (63.1%) had no labetalol medication. Results: Of the 103 patients, 24 (23.3%) required treatment for hyperkalemia. Thirteen (34.2%) of the patients who had labetolol medication and 11 (16.9%) of the patients who did not receive labetalol were treated for hyperkalemia (p = 0.045). Factors considered for a logistic regression model included: the use of labetalol, cold ischemia time, diabetes, and dialysis method; intake of tacrolimus, beta blockers, angiotensin-converting enzyme inhibitors, or other antihypertensives prior to admission; the mannitol dose given intraoperatively, and the 24-hour urine output postoperatively. Intravenous labetalol (odds ratio OR = 4.52, confidence interval CI = 1.33–15.28; p = 0.02), 24- hour urine output (OR = 4.4, CI = 0.97–20.1: p = 0.47), increasing cold ischemia time (OR = 1.09, CI = 1.01–1.17; p = 0.02), and continuous ambulatory peritoneal dialysis (OR = 0.17, CI = 0.29-0.98; p = 0.036) were independent predictors. Conclusion: Labetalol appears to increase the risk of hyperkalemia in patients after renal transplantation.

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          Most cited references 2

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          Succinylcholine-induced hyperkalemia in neuromuscular disease.

           L H Cooperman (1970)
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            Life-Threatening Hyperkalemia after Intravenous Labetolol Injection for Hypertensive Emergency in a Hemodialysis Patient

            Intravenous labetolol, a nonselective α- and β-blocking drug, is commonly used to treat severe hypertension. Nonselective β-blockers can cause hyperkalemia, especially in patients with renal failure. One series reported 3 renal transplant patients who had hyperkalemia after labetolol infusion, but none of these patients developed any serious complication. We report a case of life-threatening hyperkalemia (serum [K + ] 9.9 mEq/l) with ventricular tachycardia and hypotension in a patient on maintenance hemodialysis who received labetolol for a hypertensive emergency. Physicians should be aware of this potentially lethal complication, which is easily preventable.
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              Author and article information

              Journal
              AJN
              Am J Nephrol
              10.1159/issn.0250-8095
              American Journal of Nephrology
              S. Karger AG
              0250-8095
              1421-9670
              2002
              August 2002
              02 August 2002
              : 22
              : 4
              : 347-351
              Affiliations
              aRenal Electrolyte Division and bDivision of Transplantation Surgery, Departments of Medicine and Surgery and Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA
              Article
              65225 Am J Nephrol 2002;22:347–351
              10.1159/000065225
              12169866
              © 2002 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Tables: 1, References: 21, Pages: 5
              Product
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/65225
              Categories
              Clinical Study

              Cardiovascular Medicine, Nephrology

              Labetalol, Dialysis, Hyperkalemia, Renal transplantation

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