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Case Reports:
A. J. Olufolabi, G. A. Charlton, S. A. Allen, I. M. Mettam, and P. R. Roberts
Use of implantable cardioverter defibrillator and anti-arrhythmic agents in a parturient
Br. J. Anaesth. 2002; 89: 652-655 [Abstract] [Full text] [PDF]
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[Read E-letter] Serum electrolytes correction is a must
Niraj Sinha, Peter Krismann (Consultant)   (21 July 2009)

Serum electrolytes correction is a must 21 July 2009
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Niraj Sinha
Corniche Hospital, Abu Dhabi,
Peter Krismann (Consultant)

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Re: Serum electrolytes correction is a must

Olufolabi Et al case report was very informative (1). Recently we came across a patient for Grade 1 c Caesarean section with no antenatal follow up. She was found to have history of palpitation, dizziness and syncope from before pregnancy. She was full stomach, her vitals included a heart rate of 130/min; ECG showed a sinus rhythm with multifocal ventricular ectopics (>5-10/minute) and a BP of 140/100 mm Hg.

She was given spinal anaesthetic with phenylephrine infusion. She developed bradycardia (HR<50/minute) after induction and ECG broke into ventricular bigeminy which persisted till a cardiologist started treating her with carvedilol, post operatively. She also had placenta praevia and bled around 2 litres for which volume resuscitation was done. Operation was completed successfully and a healthy baby boy was delivered. She was sent to HDU were she had two episodes of self limiting ventricular tachycardia. She maintained haemodynamic stability without inotropic support. She was found to have potassium of 2.9 and magnesium of 0.6 meq/l. Her echocardiograph showed concentric left ventricular hypertrophy. We conclude that

1. low potassium and magnesium is common in pregnancy and may contribute to arrhythmia in predisposed parturients. Serum electrolyte correction is a must.

2. Tachycardia protects parturients from more ominous rhythms; patients continue to be vulnerable in post partum period.

3. If patient is stable haemodynamically , anti arrhythmic agents may be withheld till expert advice is available.

Reference: 1. A. J. Olufolabi, G. A. Charlton, S. A. Allen, I. M. Mettam, and P. R. Roberts. Use of implantable cardioverter defibrillator and anti-arrhythmic agents in a parturient. Br. J. Anaesth. 2002; 89: 652- 655

Conflict of Interest:

None declared