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Acute life-threatening hyperkalaemia in a patient with giant hydronephrosis: a case report
  1. Nicole van Vlijmen1,
  2. Robert Hoekstra2,
  3. Albert-Jan Aarnoudse3 and
  4. Donna van den Bersselaar1
  1. 1Department of Emergency Medicine, Catharina Hospital Eindhoven, Eindhoven, Netherlands
  2. 2Department of Urology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
  3. 3Department of Internal Medicine – Division Nephrology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
  1. Correspondence to Dr Nicole van Vlijmen; nicolevanvlijmen{at}


A 52-year-old man with a history of urolithiasis presents to the emergency department with a sudden, sharp, continuous right flank colicky pain. Laboratory workup demonstrates acute kidney injury with a mild hyperkalaemia. During the observation period, the patient develops an atypical broad complex sinus bradycardia and eventually short asystolic periods. This was caused by a severe therapy-resistant hyperkalaemia, wherefore emergency haemodialysis was necessary. Radiographic results showed a giant hydronephrosis with a blowout of the right kidney and an obstructing calculi of 21 mm in the distal ureter. We will discuss the mechanism of reversed intraperitoneal dialysis causing the refractory hyperkalaemia and the need of close ECG monitoring in patients where kidney blowout is considered.

  • arrhythmias
  • urology
  • fluid electrolyte and acid-base disturbances
  • dialysis
  • acute renal failure

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  • Contributors NvV, DvdB, A-JA and RH: Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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