Neonatal Hyperkalemia

1
Neonatal Hyperkalemia
Mother 30 years old. 2nd pregnancy US at 28
wks normal kidneys Delivery at 33 weeks.
Female. Birth Wt 1650 g Apgar
4-7 RDS
2
Neonatal Hyperkalemia
Day 4 Cardiac arrhythmia BP 65/45 mmHg Na/K
134/7.7 mEq/L pH 7.22 and tCO2 12
mmol/L URINE RBC 1, protein 1, Na 45
mmol/L US no dilatation of urinary tract
3
Neonatal Hyperkalemia
Serum creatinine concentration 2.3 mg/dl Urine
volume 1.2 ml/kg/hour
Definition of hyperkalemia Glucose and insulin
infusion ??? Kayexalate ???
4
Neonatal Hyperkalemia - Definition

• K gt 6.5 or 7 mEq/L
• In older children gt 5,5 mEq/L
• Major problem of hyperkalemia
• Cardiac arrythmias 25-35
• Death (? ).

5
Neonatal Hyperkalemia -Management
Glucose and insulin infusion Glucose/insulin
ratio 2.0-2.5 g/IU, Delivered dextrose 0.45
g/kg/h In addition to the pre-existing
stable maintenance glucose intake Lui K et al
Acta Paediatr 1992 81(3)213-6
Kayexalate 1 gm/Kg rectally every four hours Lui
K et al Acta Paediatr 1992 81(3)213-6
6
Neonatal Hyperkalemia -Management
Glucose and insulin infusion versus Kayexalate
Duration of hyperkalemia (hours) 26.4 /- 14.9
(GI) and 38.6 /- 13.3 (Kayexalate) Grade II and
above intraventricular hemorrhage 15 (3/20) and
50 (10/20) Cardiac dysrhythmias 5 (1/20) and
10 (2/20)

Hu PS et al 1999
7
Neonatal Hyperkalemia - Differential diagnosis

• Acute and chronic renal failure
• Adrenal insufficiency
• Hyporeninemic hypoaldosteronism
• Transcellular redistribution of K.
• Acute tissue breakdown
• Transfusion of red cells with high K levels.
• Gordon syndrome
• (hypertension with hyperkalemic acidosis)