Fluid and Electrolyte Physiology in the Fetus and Neonate

Ashoor, Isa; Jesus-Gonzalez, Nilka de; Somers, Michael J.

doi:10.1007/978-3-642-39988-6_3

Cited by 3 publications

(4 citation statements)

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“…Potassium was lower at higher GA in C/s deliveries, compared to preserved levels over the GA range in vaginal births (Figure 1, Panel A). Because of active transplacental ion transport, fetal plasma potassium concentration is known to generally exceed maternal levels (10,11). Our potassium preterm cord blood reference interval of 2.7-7.9 mmol/L was broader and exceeded the normal adult reference interval of 3.5-5mmol/L (9,12).…”

Section: Accepted Manuscriptmentioning

confidence: 57%

“…Because of active transplacental ion transport, fetal plasma potassium concentration is known to generally exceed maternal levels. 10 11 Our potassium preterm cord blood reference interval of 2.7 to 7.9 mmol/L was broader and exceeded the normal adult reference interval of 3.5 to 5 mmol/L. 9 12 The relationship to delivery mode came as a surprise to us.…”

Section: Discussionmentioning

confidence: 89%

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Cord-Blood Derived Chemistry Reference Values in Preterm Infants for Sodium, Chloride, Potassium, Glucose, and Creatinine

et al. 2022

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Objectives: Guidelines recommend preterm infants be supported to maintain their serum electrolytes within “normal” ranges. In term babies, cord blood values differed in pathological pregnancies from healthy ones. Study design: We examined cord blood sodium, chloride, potassium, glucose, and creatinine to derive maturity-related reference intervals. We examined associations with gestational age, delivery mode, singleton versus multiple, and prenatal maternal adverse conditions. We compared preterm cord values to term, and to adult reference ranges. Results: There were 591 infants, 537 preterm and 54 term. Preterm cord glucose levels were steady (3.7+/-1.1mmol/l), while sodium, chloride and creatinine increased over GA by 0.17, 0.14 and 1.07 micromol/week respectively (p<0.003). Average preterm cord potassium and chloride were higher than term (p<0.05). Compared to adult reference intervals, cord preterm reference intervals were higher for chloride (100-111 vs 98-106 mmol/l), lower for creatinine (29-84 vs 62-115 micromol/l), more variable for potassium (2.7-7.9 vs. 3.5-5.0 mmol/l) and sodium (130-141 vs. 136-145 mmol/l). Cesarean section was associated with higher potassium and lower glucose; multiple births with higher chloride and creatinine and lower glucose; SGA with lower glucose. Conclusions: Cord blood values vary across the GA range with increases in sodium, chloride and creatinine while glucose remained steady. Average preterm reference values were higher than term values for potassium and chloride. Preterm reference values differed from published adults’ reference values. The varies across GA and by delivery mode, SGA, and being a multiple, which may have direct implications for neonatal care and fluid management.

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Section: Accepted Manuscriptmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 89%

Cord-Blood Derived Chemistry Reference Values in Preterm Infants for Sodium, Chloride, Potassium, Glucose, and Creatinine

et al. 2022

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“…One possible explanation as to the cause of the early onset hyperkalemia is maternal hyperkalemia caused by hypermagnesemia [ 7 ]. Usually, the fetal plasma K + ion concentration is higher than the maternal plasma concentrations [ 10 ] because of active K + ion transport across the placenta [ 11 ]. In this case, the maternal potassium concentration increased from 4.3 mmol/L at 7 h before delivery to 6.0 mmol/L at 7 h after delivery.…”

Section: Discussionmentioning

confidence: 99%

Early-onset neonatal hyperkalemia associated with maternal hypermagnesemia: a case report

et al. 2018

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BackgroundNeonatal nonoliguric hyperkalemia (NOHK) is a metabolic abnormality that occurs in extremely premature neonates at approximately 24 h after birth and is mainly due to the immature functioning of the sodium (Na+)/potassium (K+) pump. Magnesium sulfate is frequently used in obstetrical practice to prevent preterm labor and to treat preeclampsia; this medication can also cause hypermagnesemia and hyperkalemia by a mechanism that is different from that of NOHK. Herein, we report the first case of very early-onset neonatal hyperkalemia induced by maternal hypermagnesemia.Case presentationA neonate born at 32 weeks of gestation developed hyperkalemia (K+ 6.4 mmol/L) 2 h after birth. The neonate’s blood potassium concentration reached 7.0 mmol/L 4 h after birth, despite good urine output. The neonate and his mother had severe hypermagnesemia caused by intravenous infusion of magnesium sulfate given for tocolysis due to pre-term labor.ConclusionThe early-onset hyperkalemia may have been caused by the accumulation of potassium ions transported through the placenta, the shift of potassium ions from the intracellular to the extracellular space in the infant due to the malfunctioning of the Na+/K+ pump and the inhibition of renal distal tube potassium ion secretion, there is a possibility that these mechanisms were induced by maternal and fetal hypermagnesemia after maternal magnesium sulfate administration. Because neonatal hyperkalemia poses a significant risk for the development of life-threatening cardiac arrhythmia, this case highlights the necessity of maternal blood magnesium monitoring during magnesium sulfate administration and neonatal blood potassium monitoring when there is severe maternal hypermagnesemia at delivery.

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“…Neonatal plasma sodium at birth varies greatly, as normal values vary between 133 and 144 mmol/L (57). In literature fetal plasma sodium is reported equal or lower than maternal plasma sodium (58,59). One study found that fetal chloride was higher than maternal chloride at all stages of pregnancy (60).…”

Section: Feto-maternal Electrolyte and Albumin Relationshipmentioning

confidence: 99%