Introduction — Hyperkalemia, defined as serum potassium >6.0mmol/L, affects ±6% of people with kidney disease and is a contraindication to surgery due to the perioperative risk of potentially fatal cardiac dysrhythmia (1,2,3). When emergency surgery cannot be avoided, hyperkalemia must be managed perioperatively using a variety of traditional practice patterns which vary in efficacy (3,4,5). We present a case report of successful rapid correction of hyperkalemia in a 67-year- old man with a history of chronic kidney disease who presented to the emergency department for acute compartment syndrome in need of emergent fasciotomy to prevent loss of limb. Methods — Since emergent treatment of hyperkalemia is often managed through a combination of medications with multiple mechanisms of action, we reviewed available related literature in PubMed in order to present this educational case report. Patient Presentation — At the time of presentation, our patient’s serum potassium was 7.7mmol/L, creatinine kinase was 33,160U/L, and an ECG revealed a first-degree AV node block with slight ST depression. Following intubation, as a team of surgeons started extensive fasciotomy of his arm, our anesthesia team gave several medications in tandem—calcium gluconate to stabilize cardiac myocytes and prevent ventricular arrythmia, coadministration of dextrose and insulin to induce an intracellular shift of potassium, sodium bicarbonate to induce cellular hydrogen/potassium exchange, and albuterol to increase cellular uptake of potassium via β2 adrenergic receptors (1,6). The patient’s hyperkalemia improved from 7.7 to 3.7 (normal 3.5 – 5.1mmol/L) over 4 hours. Discussion and Conclusion — Our review of available literature identified several methods of treatment of hyperkalemia, some with limitations to use which we believe support our team’s approach to treatment in this case report (6). Calcium salts are integral to the treatment of hyperkalemia by stabilizing cardiac myocytes, however they do not directly influence serum or total body potassium levels. Our report adds to a growing pool of existing case reports and small studies documenting safe, efficacious emergent treatment of hyperkalemia. It also describes the utility of the anesthesiologist in providing safe, effective perioperative medical care.

Compartment syndrome is a rare but a well-documented complication in patients with trauma-induced group A streptococcus infection. Here, we present a case of a male who developed compartment syndrome on the left lower extremity after an injury inoculated by group A streptococcus on the right lower extremity. The patient was resuscitated with antibiotics, urgent fasciotomy, and immunoglobulin. The patient was eventually transferred to a burn center for further care.