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Journal of Medical Case Reports

, 7:207

First Online: 14 August 2013Received: 18 February 2013Accepted: 20 June 2013DOI: 10.1186-1752-1947-7-207

Cite this article as: Kononowa, N., Dickenmann, M.J. & Kim, M.J. J Med Case Reports 2013 7: 207. doi:10.1186-1752-1947-7-207


IntroductionPotassium K homeostasis in healthy subjects is maintained mainly by urinary excretion of K. In patients with end-stage renal disease, the intestinal tract might assume an accessory K excretory role in the face of declining renal excretory function. Here, we report the case of a patient with end-stage renal disease who developed severe hyperkalemia following colon diversion surgery.

Case presentationA 56-year-old Caucasian woman undergoing hemodialysis experienced ischemic colitis, leading to ileocecal resection and a temporary ileostomy. She made a good recovery and her dietary intake improved. However, her pre-dialysis serum K level three weeks later was 7.2mmol-L, which was much higher than her previous level range 4.9 to 6.1mmol-L. Despite dietary restriction of K and use of oral cation-exchange resin and low K dialysate, her serum K level remained high 6.1 to 8.3mmol-L. Six months later, her bowel continuity was restored and her serum K decreased to the previous level. Her fecal K concentration before and after stoma reversal showed a marked difference: 23mmol-L before and 60mmol-L after.

ConclusionsWe assume that the severe hyperkalemia seen in our patient was caused by reduced colonic K secretion due to the colon diversion. Our patient’s case demonstrates the importance of colonic K secretion for the maintenance of K homeostasis in patients with end-stage renal disease.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-7-207 contains supplementary material, which is available to authorized users.

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Autor: Nina Kononowa - Michael J Dickenmann - Min Jeong Kim


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