Prophylactic Calcium Administration for Hyperkalemia in Extremely Low Birthweight Infants

Abstract

The objective of this study was to clarify the relationship between the blood potassium and calcium levels, and the efficacy of prophylactic calcium (Ca) administration early in life for nonoliguric hyperkalemia in extremely low birthweight (ELBW) infants. This was a retrospective study including 55 ELBW infants with gestational age less than 26 weeks (mean, 24.4 weeks; mean body weight, 681 g). The plasma potassium concentration and whole blood ionized calcium (iCa) concentration were measured every 2 to 3 hours. Laboratory data obtained up to 24 hours after birth were collected. The infants were divided into two groups based on whether or not Ca gluconate was administered prophylactically starting at admission (prophylactic and nonprophylactic group). There was a negative correlation between the plasma potassium and iCa levels at 12 and 24 hours, and the maximum plasma potassium level was higher in the hypocalcemia group (minimum iCa level, < 0.9 mmol/L) than in the normocalcemia group. The iCa level was significantly higher and the plasma potassium level was significantly lower in the prophylactic group than in the nonprophylactic group at 12 and 24 hours. The increment in the plasma potassium level at 24 hours compared with that at admission was significantly lower in the prophylactic than in the nonprophylactic group. Nonoliguric hyperkalemia may be attenuated by maintaining the iCa level within normal limits by prophylactic Ca administration early in life. Prospective studies are needed to confirm this.

Non-Oliguric Hyperkalemia in Extremely Low Birth Weight Infants

“…Fukuda found that hypocalcemia was more common in preterm infant who had serum potassium >7 mmol/L,32 and Iijima, et al33 reported a negative correlation between the plasma potassium and ionized calcium levels at PN 12 and 24 hours, concluding that NOHK may be attenuated by maintaining the ionized calcium level within normal limits by prophylactic calcium administration early in life. However, we could find no statistically significant difference in calcium administration between NOHK and non-NOHK groups.…”

High‐dose calcium reduces early‐onset hyperkalemia in extremely preterm neonates

“…Early‐onset hyperkalemia was defined as plasma potassium concentrations exceeding 6.5 mmol/L within 72 h after birth, as reported previously . The combination of insulin and glucose was employed in most patients with hyperkalemia, or when attending neonatologists recognized the necessity of insulin in patients whose plasma potassium concentrations were increasing rapidly.…”

“…Hyperkalemia is often accompanied by hypocalcemia in ELBW infants . A previous study showed that prophylactic calcium administration reduces plasma potassium concentrations at 12 and 24 h after birth in patients without hyperkalemia . These studies suggest the possibility that high‐dose infusion of calcium may reduce early‐onset hyperkalemia.…”

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

“…The plasma potassium level during the first 72 h in P1 and P2 was the same. Two studies have reported that calcium supplementation decreased the potassium level prophylactically 12) , and that the effect was dose-related 13) .…”

“…Supplementation of calcium to preterm infants after birth may provide their calcium requirements and decrease the arrhythmogenic effect of NOHK by stabilizing the cell membranes. Very little research has been performed on the effects of calcium supplementation for NOHK 12,13) . For years, we have provided high-dose calcium supplementation to very premature infants during the first few days of life (DOLs) to meet their requirements, control potassium levels, and overcome the arrhythmogenic effect of NOHK 13) .…”