[A case of intraoperative hyperkalemia induced with administration of an angiotensin II receptor antagonist (AIIA) and intake of dried persimmons]

Masui. 2004 May;53(5):543-6.
[Article in Japanese]


An 87-year-old man was scheduled for cervical laminectomy. Anesthesia was maintained with nitrous oxide, oxygen, sevoflurane, and fentanyl with tracheal intubation. Thirty minutes after the start of operation, serum potassium was 7.41 mEq x l(-1). We immediately administered potassium-free fluid, furosemide, bicarbonate, calcium gluconate and insulin. We stopped the operation and returned the patient to supine position, but he fell into ventricular fibrillation. Immediate CPR and countershock successfully restored sinus rhythm within 5 minutes. He was discharged from ICU without any neurological complications. Daily he took Losartan potassium, an AIIA, due to hypertension and ate preoperatively dried persimmons, a potassium-rich food. We suspect that hyperkalemia was induced by administration of an AIIA in combination with excessive intake of dried persimmons. AIIA may cause severe hyperkalemia inhibiting aldosterone activity. We should pay attention to the serum potassium level and a preoperative intake of food especially in a patient medicated with an AIIA.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiotensin Receptor Antagonists*
  • Antihypertensive Agents / adverse effects*
  • Diospyros / adverse effects
  • Heart Arrest / etiology*
  • Humans
  • Hyperkalemia / chemically induced*
  • Hypertension / drug therapy
  • Intraoperative Complications*
  • Laminectomy
  • Losartan / adverse effects*
  • Male


  • Angiotensin Receptor Antagonists
  • Antihypertensive Agents
  • Losartan