Orv Hetil. 2026 Oct 11;167(41):1664-1668. doi: 10.1556/650.2026.33650. Print 2026 Oct 11.
ABSTRACT
Severe hypokalemia is a rare but potentially reversible cause of malignant arrhythmias and cardiac arrest. Early recognition of significant fluid, electrolyte, and acid-base disturbances in patients with intestinal urinary diversion may be life-saving. We present the clinical course of a 55-year-old woman who developed severe hyperchloremic metabolic acidosis and extreme hypokalemia following prolonged vomiting and high-output fluid loss through a Bricker ureteroileocutaneostomy. The patient was admitted to the intensive care unit in a peri-arrest condition, where cardiac arrest occurred shortly thereafter. The monitored rhythm was ventricular fibrillation alternating with "torsade de pointes" ventricular fibrillation. During advanced life support, targeted high-dose intravenous potassium replacement, magnesium sulfate administration, and bicarbonate substitution were performed. A total of 120 mL of 7.4% potassium chloride was administered during resuscitation, resulting in return of spontaneous circulation after approximately 18 minutes. During the first 24 hours, a total of 460 mmol potassium chloride replacement was required. Following the return of spontaneous circulation, intermittent hemodialysis was performed to correct severe metabolic acidosis. During subsequent intensive care treatment, sepsis and bilateral pneumonia developed; however, with targeted antimicrobial therapy, organ support, and continuous electrolyte correction, the patient's condition gradually improved. Successful extubation was performed on day 7, and the patient was transferred back to the nephrology ward with favourable neurological outcome. This case highlights that rapidly developing severe hypokalaemia and metabolic acidosis in patients with Bricker urinary diversion may lead to malignant arrhythmias and cardiac arrest; however, prompt recognition of reversible metabolic abnormalities and aggressive targeted potassium replacement can be life-saving. Orv Hetil. 2026; 167(41): 1664-1668.
PMID:42859976 | DOI:10.1556/650.2026.33650