A five-year-old aggressive female spayed rottweiler presenting for bilateral elbow arthroscopy developed an acute life-threatening hyperkalaemia intraoperatively under general anaesthesia. The dog was premedicated with a combination of ketamine (9.5 mg/kg), medetomidine (0.033 mg/kg) and morphine (0.3 mg/kg) intramuscularly. The effect of the premedication was considered moderate. Anaesthesia was induced 30 minutes later with intravenous propofol and maintained with isoflurane in oxygen and air. Profound bradycardia (heart rate falling from 95 to 33 beats per minute) occurred at 140 minutes after administering the premedication. Initially, high vagal tone was suspected and anticholinergic drugs (atropine and glycopyrrolate) were administered with minimal effect. The bradycardia was permanently corrected with epinephrine and atipamezole treatment. A definitive diagnosis of hyperkalaemia was made postoperatively on analysis of serum samples collected intraoperatively. This case report discusses the potential causes of hyperkalaemia in this case and other veterinary reports using similar drug combinations.
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Contributors KJB and GZ managed the perianaesthetic period of the patient, and both wrote the case report.
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.
Data availability statement All data relevant to the study are included in the article.
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