Abstract
A 36-year-old parturient with a suspicion of placenta accreta under tocolytic therapy with ritodrine infusion underwent emergency cesarean section under general anesthesia with propofol, ketamine, and remifentanil because massive bleeding was anticipated. The ritodrine infusion was discontinued 1 h before cesarean section. The baby was delivered 6 min after induction of anesthesia. However, after the manual removal of the placenta from the uterus, the bleeding was massive and uncontrollable. We rapidly transfused crystalloid, colloid, and red blood cells through potassium removal filter. Hyperkalemia (5.8 mmol/L) was detected just before blood transfusion. One hour later, hemostasis was still difficult, and hyperkalemia was promoted (6.1 mmol/L). Thus, glucose insulin therapy started with intravenous furosemide to treat hyperkalemia. Gynecologists decided to induce the Bakri balloon tamponade for the treatment of postpartum hemorrhage. At the end of surgery, plasma potassium level also reduced to 5.5 mmol/L. In the ICU, the bleeding still continued, and then radiologists performed bilateral internal iliac artery embolization for full hemostasis. Postoperative plasma potassium level was stable and 3.3 mmol/L in the next morning. Although one of the common adverse reactions of ritodrine is hypokalemia, we should also beware of a rebound hyperkalemia after its cessation.
Highlights
Ritodrine, a β2-adrenergic agonist, is widely used for tocolytic therapy in parturients
One of the common adverse effects of β2-agonists is hypokalemia [1], which is due to an increase in uptake of extracellular potassium by promoting insulin secretion in pancreatic islets with β2 adrenoceptor stimulation [2]
We experienced a case revealing a rebound hyperkalemia after cessation of ritodrine. This adverse reaction may rarely occur as only five case reports have been found by PubMed search [3,4,5,6,7]
Summary
A β2-adrenergic agonist, is widely used for tocolytic therapy in parturients. We experienced a case revealing a rebound hyperkalemia after cessation of ritodrine This adverse reaction may rarely occur as only five case reports have been found by PubMed search [3,4,5,6,7]. On the 3rd day after admission, tocolytic therapy against frequent uterine contractions started with intravenous infusion of ritodrine at 50 μg/min. Crystalloid (800 mL), colloid (HES 130/0.4) (1500 mL), 5% albumin (500 mL), and packed red blood cell (6 units) were totally transfused during operation She postoperatively moved to the intensive care unit under propofol sedation with tracheal intubation. The postoperative course was uneventful and plasma potassium level was 3.3 mmol/L in the morning She was discharged from the hospital on foot without any sequelas on the 13th postoperative day
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