Q) A 50 year old male undergoes pancreatectomy for Carcinoma head of pancreas. His pre op Hb was 9.2g% and during surgery he received 5 units of PRBC. In the post op period on the 2nd day he develops ECG changes. Work up is done for Myocardial Ischemia which is negative. What is the most common  cause of ECG changes here

a) Hyponatremia

b) Hyperkalemia

c) Hypokalemia

d) Hypercalcemia

Free Answer  b, Hyperkalemia

Transfusion of high volume of  PRBC especially stored blood leads to hyperkalemia. In the setting of pancreatectomy in an already anemic patient, if massive blood transfusion is given, chances of hyperkalemia  are there.

The ECG changes of Hyperkalemia are tall T waves, shortened QT interval and ST segment depression