Background. The aim of this study is to investigate the evidence of hypokalemia as a suitable parameter for therapeutic decision making after severe blunt liver trauma. Methods. We reviewed the medical records of 11 patients (9 M, 2 F, mean age 32 years) admitted to San Matteo Hospital of Pavia between 2007–2009. All of them were victims of road accidents hospitalized for blunt liver injury and submitted to surgery. Results. Hypokalemia was observed in 7/11 (63.6%) patients during the preoperative period (mean value 2.91？mEq/L). Serum potassium concentration normalized in all patients at the 7th postoperative day only ( ). Conclusions. According to literature results, our study confirms that after blunt hepatic injury serum potassium levels may decrease significantly. Therefore, kalemia must be carefully monitored in order to establish appropriate treatment and avoid any complications. 1. Introduction Trauma patients are shown to have a high incidence of admission hypokalemia, which predicts the seriousness of trauma itself. It is often associated to hyperglycemia and is subsequent to circulating epinephrine [1]. Serum potassium decrease is particularly frequent in young patients with blunt head trauma or spinal cord trauma and has a worsening prognostic implication in terms of morbidity and mortality [2]. Concerning blunt abdominal trauma, significant hypokalemia has been observed in patients with liver injury. On the contrary, no hypokalemia has been described in patients with other abdominal visceral injuries (e.g., spleen, mesentery) [3–5]. Besides elevation of serum aspartate and alanine aminotransferases (AST and ALT) [6, 7], there is evidence of a few-day-lasting hypokalemia [4, 5], despite the normal values of other serum electrolytes (Na+, Cl？), daily urinary potassium and blood acid-base balance. The aim of the present study is to investigate the evidence of hypokalemia as a suitable parameter for therapeutic decision making after severe blunt liver trauma. 2. Materials and Methods We reviewed a personal series of 11 patients (9？M, 2 F, mean age 32 years) admitted to San Matteo Hospital of Pavia between 2007–2009. All of them were victims of road accidents and hospitalized for blunt liver injury (III-V grade according to Moore organ injury scaling) [8] without any other abdominal visceral lesions associated (Table 1). Table 1: Clinical series of 11 patients with blunt liver injury submitted to surgery. D1, D3 and D7 are, respectively, the 1st, 3rd and 7th postoperative day. Within the first 12–24 hours from admission, they were all submitted
References
[1]
A. L. Beal, W. E. Deuser, and G. J. Beilman, “A role for epinephrine in post-traumatic hypokalemia,” Shock, vol. 27, no. 4, pp. 358–363, 2007.
[2]
A. L. Beal, K. E. Scheltema, G. J. Beilman, and W. E. Deuser, “Hypokalemia following trauma,” Shock, vol. 18, no. 2, pp. 107–110, 2002.
[3]
O. J. McAnena, E. E. Moore, and J. A. Marx, “Initial evaluation of the patient with blunt abdominal trauma,” Surgical Clinics of North America, vol. 70, no. 3, pp. 495–515, 1990.
[4]
S. Pollice, M. Pampolini, G. Teutonico, et al., “Hypokalemia due to hepatic traumas,” Chirurgia Epatobiliare, vol. 4, pp. 47–50, 1985 (Italian).
[5]
G. Zavagli, M. Pampolini, G. Cavallini, G. Cavallesco, and G. Ricci, “Different kalemia in abdominal trauma,” Journal of Trauma, vol. 28, no. 4, pp. 526–529, 1988.
[6]
A. H. Ritchie and D. M. Williscroft, “Elevated liver enzymes as a predictor of liver injury in stable blunt abdominal trauma patients: case report and systematic review of the literature,” Canadian Journal of Rural Medicine, vol. 11, no. 4, pp. 283–287, 2006.
[7]
K. K. Tan, S. L. Bang, A. Vijayan, and M. T. Chiu, “Hepatic enzymes have a role in the diagnosis of hepatic injury after blunt abdominal trauma,” Injury, vol. 40, no. 9, pp. 978–983, 2009.
[8]
E. E. Moore, T. H. Cogbill, G. J. Jurkovich, S. R. Shackford, M. A. Malangoni, and H. R. Champion, “Organ injury scaling: spleen and liver,” Journal of Trauma, vol. 38, no. 3, pp. 323–324, 1995.
[9]
F. Wilcoxon, “Individual comparisons by ranking methods,” Biometrics, vol. 1, pp. 80–83, 1945.
[10]
L. D. Stracieri and S. Scarpelini, “Hepatic injury,” Acta Cirurgica Brasileira, vol. 21, no. 1, supplement, pp. 85–88, 2006.
[11]
O. Warren, J. Kinross, P. Paraskeva, and A. Darzi, “Emergency laparoscopy—current best practice,” World Journal of Emergency Surgery, vol. 1, no. 1, article 24, pp. 24–32, 2006.
[12]
M. A. Croce, T. C. Fabian, P. G. Menke et al., “Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients: results of a prospective trial,” Annals of Surgery, vol. 221, no. 6, pp. 744–753, 1995.
[13]
M. Zargar and M. Laal, “Liver trauma: operative and non-operative management,” International Journal of Collaborative Research on Internal Medicine and Public Health, vol. 2, no. 4, pp. 96–107, 2010.
[14]
S. Gourgiotis, V. Vougas, S. Germanos et al., “Operative and nonoperative management of blunt hepatic trauma in adults: a single-center report,” Journal of Hepato-Biliary-Pancreatic Surgery, vol. 14, no. 4, pp. 387–391, 2007.
[15]
P. C. Canizaro and M. E. Pessa, “Management of massive hemorrhage associated with abdominal trauma,” Surgical Clinics of North America, vol. 70, no. 3, pp. 621–634, 1990.
[16]
D. B. McConnell and D. D. Trunkey, “Nonoperative management of abdominal trauma,” Surgical Clinics of North America, vol. 70, no. 3, pp. 677–688, 1990.
[17]
R. L. Vick, E. P. Todd, and D. W. Luedke, “Epinephrine-induced hypokalemia: relation to liver and skeletal muscle,” Journal of Pharmacology and Experimental Therapeutics, vol. 181, no. 1, pp. 139–146, 1972.
[18]
M. J. Brown, D. C. Brown, and M. B. Murphy, “Hypokalemia from beta2-receptor stimulation by circulating epinephrine,” New England Journal of Medicine, vol. 309, no. 23, pp. 1414–1419, 1983.
[19]
R. A. De Fronzo, M. Bia, and G. Birkhead, “Epinephrine and potassium homeostasis,” Kidney International, vol. 20, no. 1, pp. 83–91, 1981.
[20]
U. Aydin, P. Yazici, I. Alper, et al., “Management of resistant cardiac depression after hepatic trauma controlled with a packing procedure,” The Eurasian Journal of Medicine, vol. 41, pp. 66–69, 2009.
[21]
D. V. Feliciano and G. S. Rozycki, “Hepatic trauma,” Scandinavian Journal of Surgery, vol. 91, no. 1, pp. 72–79, 2002.
