BMJ Case Reports 2012; doi:10.1136/bcr-2012-007804

Survival after cardiopulmonary arrest with extreme hyperkalaemia and hypothermia in a patient with metformin-associated lactic acidosis

  1. I-Lynn Lee2
  1. 1Department of Anaesthesia, Royal Darwin Hospital, Darwin, Northern Territory, Australia
  2. 2Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
  1. Correspondence to Dr Stan Tay, stanley.tay{at}


Potassium levels are regularly used as a prognostic factor to cease resuscitation in significant hypothermia. In this case report, we highlight how survival is still possible with extreme hyperkalaemia in severe hypothermia. We present a case of a 65-year-old Caucasian man who presented with metformin associated lactic acidosis. On presentation he had potassium of 9.1 mmol/l and a temperature of 31.5°C. Cardiopulmonary resuscitation was commenced when he went into asystolic arrest. This presentation would commonly make attempts at resuscitation futile with a 100% death rate. However, with appropriate management this patient's condition improved and survival was possible. We provide evidence that survival is possible in profound hyperkalaemia and hypothermia. Effective cardiopulmonary resuscitation with early haemofiltration can be successful.

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