Acute hyperkalemia associated with intravenous epsilon-aminocaproic acid therapy

Epsilon-aminocaproic acid (Amicar) is used to treat severe hemorrhage refra ctory to usual medical management. This antifibrinolytic drug has been asso ciated with a number of renal complications. However, there are no descript ions of this medication causing hyperkalemia, This report describes the dev elopment of hyperkalemia in a patient with underlying chronic renal insuffi ciency treated with intravenous epsilon-aminocaproic acid. The patient, who underwent coronary artery bypass grafting, had no other obvious cause for the acute increase in serum potassium concentration. Based on data in anima ls and humans, the cationic amino acids lysine and arginine have been shown to enter muscle cells in exchange for potassium and lead to hyperkalemia t hrough a shift of potassium from the intracellular to the extracellular spa ce. Epsilon-aminocaproic acid, a synthetic amino acid structurally similar to lysine and arginine, also has been noted to cause an acute increase in s erum potassium in anephric dogs infused with this medication. It is probabl e that the mechanism underlying the increase in serum potassium with epsilo n-aminocaproic acid is also based on the shift of potassium from the intrac ellular to the extracellular space. Hence, it appears that intravenous epsi lon-aminocaproic acid can also cause hyperkalemia in humans. (C) 1999 by th e National Kidney Foundation, Inc.