Nonoliguric Hyperkalemia in Neonates: A Case-Controlled Study

ABSTRACT

The objective of this study was to determine the incidence, risk factors, and morbidities associated with nonoliguric hyperkalemia (NOHK) in neonates. Infants were eligible for the study if they were born at Al Qassimi Hospital and fulfilled the diagnostic criteria of NOHK (serum potassium [SK] ≥ 7 mmol/L during the first 72 hours of life with urinary output ≥ 1 mL/kg/h). The next admitted infant with gestational age ± 1 week and normal SK acted as control. Exclusion criteria were severe congenital malformation, renal failure, failure of adequate urinary collection, and early blood transfusion within the first 72 hours of life. Fluid intake and urinary output were monitored. Infants who developed hyperkalemia (SK ≥ 6.5 mmol/L in two nonhemolysed venous or arterial blood samples) had serum potassium measured every 4 hours until it reached below 6 mmol/L. Hyperkalemia was identified between 6 and 36 hours of age in 45 infants (peak SK 7 to 9.3 mmol/L). During the time of the study, the prevalence of NOHK was 24% among extremely-low-birth-weight infants (with birth weight < 1000 g) who comprised 83% of those identified. Of infants with NOHK, 13% developed tachycardiac arrhythmia and 17% died. NOHK was significantly associated with fetal distress, early metabolic acidosis, early hyperglycemia, and absence of antenatal steroid administration. Hyperkalemic infants had significantly lower serum calcium and higher serum phosphorous, urea, and creatinine. Early polyuric episodes and high urinary output were also more common in hyperkalemic infants. NOHK affects mainly preterm infants. Electrolyte disturbance and increased serum urea and creatinine were associated with hyperkalemia. Infants with NOHK also had high incidence of cardiac arrhythmias and mortality.

Nonoliguric hyperkalemia - preterm - hyperkalemia

REFERENCES

• 1 Apitz C, Wirbelauer J. Circulatory failure due to severe cardiac arrhythmia as a result of hyperkalemia in a very low birth weight infant.  Klin Padiatr. 2006;  218 16-19
• 2 Brion L P, Schwartz G J, Campbell D, Fleichman A R. Early hyperkalemia in very low birth weight infants in the absence of oliguria.  Arch Dis Child. 1989;  64 270-272
• 3 Mildenberger E, Versmold H T. Pathogenesis and therapy of non-oliguric hyperkalemia of the premature infant.  Eur J Pediatr. 2002;  161 415-422
• 4 Stefano J L, Norman M E, Morales M C. Decreased erythrocyte Na + , K + -ATPase activity associated with cellular potassium loss in ELBW infants with non oliguric hyperkalemia.  J Pediatr. 1993;  122 276-284
• 5 Omar S A, DeCristofaro J D, Agarawal B I, LaGomma E F. Effect of prenatal steroids on potassium balance in extremely low birth weight neonates.  Pediatrics. 2000;  106 561-567
• 6 Uga N, Nemoto Y, Ishii T, Kawase Y, Arai H, Tada H. Antenatal steroid treatment prevents severe hyperkalemia in very low birth weight infants.  Pediatr Int. 2003;  45 656-660
• 7 Shortland D, Trounce J Q, Levene M I. Hyperkalemia, cardiac arrhythmia and cerebral lesions in high risk neonates.  Arch Dis Child. 1987;  62 1139-1143
• 8 Malone T A. Glucose and insulin versus cation-exchange resin for the treatment of hyperkalemia in VLBW infants.  J Pediatr. 1991;  118 121-123
• 9 Yaseen H, Khalaf M, Darwich M. Salbutamol versus Kayxalate for the treatment of non-oliguric hyperkalemia in preterm infants.  Am J Perinatol. 2008;  25 193-197
• 10 Vemgal P, Ohlsson A. Interventions for non-oliguric hyperkalemia in preterm neonates.  Cochrane Database Syst Rev. 2007;  CD005257
• 11 Singh B S, Sadiq H F, Naguchi A, Keenan W J. Efficacy of albuterol inhalation in treatment of hyperkalemia.  J Pediatr. 2002;  141 16-20
• 12 Lorenz J M, Kleinman L I, Markarian K. Potassium metabolism in extremely low birth weight infants in the first week of life.  J Pediatr. 1997;  131 81-86
• 13 Singh B S, Sadiq H F, Noguchi A, Keenan W J. Efficacy of albuterol inhalation in treatment of hyperkalemia in premature neonates.  J Pediatr. 2002;  141 16-20
• 14 Fukuda Y, Kojima T, Ono A. Factors causing hyperkalemia in premature infants.  Am J Perinatol. 1989;  6 76-79
• 15 Shaffer S G, Killbride H W, Hayen L K, Meade V M, Warady B A. Hyperkalemia in very low birth weight infants.  J Pediatr. 1992;  121 275-279
• 16 Iijima S, Uga N, Kawase Y, Tada H. Prophylactic calcium administration for hyperkalemia in extremely low birth weight infants.  Am J Perinatol. 2005;  22 211-216
• 17 Hung K C, Su B H, Lin T W. Glucose-insulin infusion for the early treatment of non-oliguric hyperkalemia in ELBW infants.  Acta Pediatr Taiwan. 2001;  42 282-286