Life-threatening hyperkalemia during radiofrequency ablation of hepatocellular carcinoma

A 48 year-old man with hepatitis C and cirrhosis was admitted for laparoscopic radiofrequency ablation of a large hepatocellular carcinoma. The patient's renal function tests and serum potassium level were all within normal limits. About 120 minutes into the procedure, the patient developed sudden, wide-complex tachycardia. Initial blood tests showed serum and plasma potassium level of 7 mEq/L, but no other abnormalities. The thermal destruction of large tumors during radiofrequency ablation may be associated with extensive cell breakdown and transcellular shift of potassium.