When Treatment Poses a Danger

A 63-year-old man was brought to the hospital by ambulance for complaints of weakness in his arms and legs. His history was significant for hepatitis C, cirrhosis of the liver, end-stage liver disease, renal failure, and congestive heart failure. The primary admission diagnoses were rhabdomyolysis, chronic kidney disease, and hepatitis C cirrhosis. Over the next 3 days, his bloodwork showed that his rhabdomyolysis was continuing to worsen. Dialysis was stopped.

The following day, the patient experienced a precipitous drop in heart rate. The physician immediately ordered an EKG which showed bradycardia and life-threating heart rhythms. The doctor made a preliminary diagnosis of hyperkalemia. As part of the treatment, he ordered the patient be given Kayexalate (sodium polystyrene sulfonate) oral suspension with sorbitol. The physician did not specifically inform the patient about the risks and benefits of the protocol before administering the Kayexalate.

The patient began experiencing severe abdominal pain and, after a precipitous drop in blood pressure, underwent exploratory surgery. His surgery lasted over 6 hours and confirmed a diagnosis of ischemic colitis, requiring the removal of almost all of the patient’s colon. Given the overall state of the patient’s perfusion, this may have likely been induced by the Kayexalate. The patient never regained consciousness and died the following day.

Was The Doctor Negligent?

(Answer and discussion on next page)