|Reviewed by Clinical Practice Committee|
|Definition and Diagnosis||Aetiology||Complications||Treatment||References|
Dose: 0.5 mL/kg IV (0.1 mmoL/kg) over 10-30 min. The dose of calcium gluconate may be repeated.
Effect: Stabilizes myocardial membrane potential, should be given if the infant is at risk of, or has ECG changes and/or arrhythmias.
Side effects: cardiac arrhythmias and seizures with severe hypercalcaemia.
Dose: dextrose: 8-16 mg/kg/min (e.g.: 2.5-5 ml/kg/hr 20% dextrose (20 ml of 50% dextrose and 30 ml of water in a 50 ml syringe)) in addition to maintenance fluid, aim for blood glucose concentration (BGC) > 12 mmol/l. When BGC >12 mmol/L, start insulin infusion (0.1-0.6 units/kg/hr).3,4
Effect: Shift of ionized K+ from the extracellular to the intracellular space. K+ is transported over the membrane in combination with glucose.
Side effects: hypoglycaemia, hyperglycaemia
Dose: intravenous: 4 micrograms/kg over
10 min or nebulized via ETT: 400 micrograms/dose (made up to a total of 4 ml
with normal saline) up to 2 hrly. 3,5,6
N.B Be aware: salbutamol comes in two different preparations, for IV administration and as sterinebs: they are not interchangeable !
Effect: Salbutamol is a beta-adrenergic agonist and stimulates the membrane Na+/K+ – ATPase. Singh et al report a small randomized trial of nebulized salbutamol compared with saline for very preterm infants. Nebulized salbutamol reduced plasma K+ rapidly with no adverse effects noted.5
Side effects: tachycardia, hypertension, tremor, hypokalaemia, hyperglycaemia. Inhaled Salbutamol seems to be generally well tolerated. 5,6
Correction of an existing metabolic acidosis can be considered
Dose: Sodium bicarbonate dose (mL) = base deficit x 0.6 x weight (kg).
Effect: may facilitate shift of K+ from the extracellular to the intracellular space.
Side effects: Increased vascular volume, serum osmolarity, serum sodium, hypercapnia and respiratory acidosis, Hypocalcaemia, oedema, congestive heart failure, hyperirritability, intraventricular haemorrhage.
Should be avoided in preterm infants
Dose: 0.5 - 1 g/kg rectally
Effect: binds intestinal K+ and prevents intestinal absorption.
Side effects: intestinal perforation and constipation in preterm infants.7 IV Salbutamol seems more effective than resonium.6
|1||Gruskay J, Costarino AT, Polin RA, Baumgart S. Nonoliguric hyperkalemia in the premature infant weighing less than 1000 grams. J Pediatr. 1988;113:381–6.|
|2||Lista G, Bastrenta P, Castoldi F, Meneghin F, Zuccotti G. Severe bradycardia in an extremely low birth weight preterm infant with hyperkalaemia. Resuscitation [Internet]. European Resuscitation Council, American Heart Association, Inc., and International Liaison Committee on Resuscitation.; 2011;82:640–1.|
|3||Vemgal P, Ohlsson A. Interventions for non-oliguric hyperkalaemia in preterm neonates. Cochrane database Syst Rev. 2012;5:CD005257.|
|4||Hu PS, Su BH, Peng CT, Tsai CH. Glucose and insulin infusion versus kayexalate for the early treatment of non-oliguric hyperkalemia in very-low-birth-weight infants. Acta Paediatr Taiwan;40:314–8.|
|5||Singh BS, Sadiq HF, Noguchi A, Keenan WJ. Efficacy of albuterol inhalation in treatment of hyperkalemia in premature neonates. J Pediatr. 2002 ;141:16–20.|
|6||Yaseen H, Khalaf M, Dana A, Yaseen N, Darwich M. Salbutamol versus cation-exchange resin (kayexalate) for the treatment of nonoliguric hyperkalemia in preterm infants. Am J Perinatol. 2008;25:193–7.|
|7||Setzer ES, Ahmed F, Goldberg RN, Hellman RL, Moscoso P, Ferrer PL, et al. Exchange transfusion using washed red blood cells reconstituted with fresh-frozen plasma for treatment of severe hyperkalemia in the neonate. J Pediatr. 1984;104:443–6.|