Treatment of hyperkalemia in neonates

The article was professionally consulted by Specialist Doctor I Nguyen Thi My Linh - Neonatologist - Pediatrics - Neonatology - Vinmec Danang International General Hospital

Hyperkalemia is common in preterm infants, with conditions related to kidney disease, adrenal gland disease. Neonates with hyperkalemia often present with general signs of fatigue, lethargy, abortion, nausea, arrhythmia, decreased or increased heart rate, generalized edema, and signs of shock.

Hyperkalemia is a higher than normal level of potassium in the blood. Potassium is a major cation in cellular electrolytes, facilitating contraction of skeletal and smooth muscle, including cardiac muscle.
Normal blood potassium level is 3.5-5 mmol/l. Hyperkalemia when potassium > 5 mmol/l. Once the blood potassium level is higher than 6.6 mmol/l, it should be treated immediately due to the risk of cardiac arrhythmias and possibly death.
Causes of neonatal hyperkalemia may be:
Oversupply: Due to oral or intravenous potassium supplements, salt substitutes, parenteral nutrition, medications containing potassium salts, blood transfusion,... Rapidly increased potassium intake, such as blood exchange, tissue necrosis. Children with acute or chronic renal failure, including acute tubular necrosis, chronic pyelonephritis, lupus nephritis, diabetic nephropathy, AIDS, obstructive uropathy, renal replacement,... reduction in potassium excretion. Due to insulin deficiency, hematoma reabsorption, gastrointestinal bleeding, mesenteric infarction, increased catabolism, malignant hyperthermia, periodic paralysis due to hyperkalemia. Mineralocorticoid deficiency: Due to Addison's disease, bilateral adrenalectomy, hypoaldosteronism due to hypo or hyperreninemia, hereditary adrenal hyperplasia. Due to drugs: Non-steroidal anti-inflammatory drugs, succinylcholine,...

Hyperkalemia is common in preterm infants, with conditions related to kidney disease, adrenal gland disease. Signs to recognize when a child has hyperkalemia include:
The whole body is tired, lethargic, refuses to breastfeed, nausea. Arrhythmia, decrease or increase in heart rate. Whole body edema, signs of shock. Elevated blood potassium levels have electrocardiographic changes: high sharp T wave, prolonged PR interval, flat P wave, wide QRS complex, sine wave, ventricular flutter, ventricular fibrillation.

Treatment of neonatal hyperkalemia is immediate discontinuation of potassium-containing infusion solutions. Treat according to cause and monitor hyperkalemia every 6-12 hours: stabilize tissue conduction: calcigluconate 10% 1 - 2 ml/kg or calcichloride 10% 0.3 - 0.6 ml/kg diluted intravenously slow pulse, 0.9% sodium chloride infusion intravenously. Dilution and intracellular potassium transfer: Sodium bicarbonate 4.2% 1-2 mEq/kg, slow intravenous infusion. Insulin + glucose 10%. Increases potassium excretion. Use diuretics: Furocemide 1mg/kg slow intravenous injection, in case renal function is not disturbed; Kayexalate 1g/kg mixed with 0.5g with 1ml of 0.9% sodium chloride pumped through rectal catheter. In case the above measures do not work, it is necessary to change blood, dialysis, dialysis, peritoneal dialysis. Cases of pseudohyperkalemia do not need to be treated and repeat the test, treat according to the cause such as: leukocytosis, thrombocytosis. Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading doctors, modern equipment and technology, but also stands out for its examination and consulting services. and comprehensive, professional medical treatment; civilized, polite, safe and sterile medical examination and treatment space.