Non-Oliguric Hyperkalemia in Extremely Low Birth Weight Infants

Abstract

PurposeIt is to examine clinical manifestations, early biochemical indicators, and risk factors for non-oliguric hyperkalemia (NOHK) in extremely low birth weight infants (ELBWI).Materials and MethodsWe collected clinical and biochemical data from 75 ELBWI admitted to Ajou University Hospital between Jan. 2008 and Jun. 2011 by reviewing medical records retrospectively. NOHK was defined as serum potassium ≥7 mmol/L during the first 72 hours of life with urine output ≥1 mL/kg/h.ResultsNOHK developed in 26.7% (20/75) of ELBWI. Among NOHK developed in ELBWI, 85% (17/20) developed within postnatal (PN) 48 hours, 5% (1/20) experienced cardiac arrhythmia and 20% (4/20) of NOHK infants expired within PN 72 hours. There were statistically significant differences in gestational age, use of antenatal steroid, and serum phosphorous level at PN 24 hours, and serum sodium, calcium, and urea levels at PN 72 hours between NOHK and non-NOHK groups (p-value <0.050). However, there were no statistical differences in the rate of intraventricular hemorrhage, arrhythmia, mortality occurred, methods of fluid therapy, supplementation of amino acid and calcium, frequencies of umbilical artery catheterization and urine output between the two groups.ConclusionNOHK is not a rare complication in ELBWI. It occurs more frequently in ELBWI with younger gestational age and who didn't use antenatal steroid. Furthermore, electrolyte imbalance such as hypernatremia, hypocalcemia and hyperphosphatemia occurred more often in NOHK group within PN 72 hours. Therefore, more use of antenatal steroid and careful control by monitoring electrolyte imbalance should be considered in order to prevent NOHK in ELBWI.

The Impact of Fluid Therapy Strategies on Nonoliguric Hyperkalemia in Extremely Low Birth Weight Infants

“…Arrhythmia developed in 13% of hyperkalemic episodes during P1. The incidence was comparable to that in a recent report from Korea 5) .…”

“…The incidence of NOHK has been reported to be 30% to 50% in very low birth weight infants 15) , and the reported incidences in ELBWIs in the Republic of Korea were 31% 16) and 26.7% 5) , which were comparable to our incidences in P1. Despite multiple bolus injections of calcium and the combination of glucose and insulin injection (44% of total hyperkalemic episodes), the mortality from NOHK was 13%.…”

“…However, NOHK remains a threat to the lives of extremely low birth weight infants (ELBWIs), and is a great challenge to neonatologists 5) .…”

Evaluating the Utility of Rapid Point-of-Care Potassium Testing for the Early Identification of Hyperkalemia in Patients with Chronic Kidney Disease in the Emergency Department

“…If left untreated, hyperkalemia can lead to an alteration of cardiac electrophysiology, which can be fatal 1,2. Severe hyperkalemia usually leads to significant morbidity and mortality if it is not immediately recognized and treated 3,4…”

Neuromuscular Junction Disorders and Floppy Infant Syndrome: A Comprehensive Review

“…Hyperkalemia is present in up to 52% of premature infants with a birth weight of less than 1000g, and hyperkalemic infants are at a high risk of developing life-threatening cardiac arrhythmias [40]. Non-oliguric hyperkalemia is characterized ours after by an excessive increase in serum potassium concentration at 24 hours after birth and is mainly due to the immature functioning of the sodium (Na + )/potassium (K + ) pump [41]. The 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 [42].…”