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      Labetalol-Induced Hyperkalemia in Renal Transplant Recipients

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          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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          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.

              Author and article information

              Am J Nephrol
              American Journal of Nephrology
              S. Karger AG
              August 2002
              02 August 2002
              : 22
              : 4
              : 347-351
              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
              65225 Am J Nephrol 2002;22:347–351
              © 2002 S. Karger AG, Basel

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              Page count
              Tables: 1, References: 21, Pages: 5
              Self URI (application/pdf):
              Clinical Study

              Cardiovascular Medicine, Nephrology

              Labetalol, Dialysis, Hyperkalemia, Renal transplantation


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