1. Neonatal Hyperkalemia Mother: 30 years old. 2nd pregnancy US at 28 wks : “normal” kidneys Delivery at 33 weeks. Female. Birth Wt 1650 g Apgar 4-7 RDS

2. Neonatal Hyperkalemia Day 4: Cardiac arrhythmia; BP 65/45 mmHg Na/K 134/7.7 mEq/L pH 7.22 and tCO2 12 mmol/L URINE RBC “1+”, protein “1+”, Na 45 mmol/L US no dilatation of urinary tract

3. Neonatal Hyperkalemia Serum creatinine concentration 2.3 mg/dl Urine volume 1.2 ml/kg/hour Definition of hyperkalemia Glucose and insulin infusion ??? Kayexalate ???

4. Neonatal Hyperkalemia - Definition • K > 6.5 or 7 mEq/L • In older children > 5,5 mEq/L • Major problem of hyperkalemia: • Cardiac arrythmias 25-35 % • Death (? %).

5. Neonatal Hyperkalemia -Management Glucose and insulin infusion Glucose/insulin ratio: 2.0-2.5 g/IU, Delivered dextrose: 0.45 g/kg/h In addition to the pre-existing stable maintenance glucose intake Lui K et al Acta Paediatr 1992 81(3):213-6 Kayexalate 1 gm/Kg rectally every four hours Lui K et al Acta Paediatr 1992 81(3):213-6

6. Neonatal Hyperkalemia -Management Glucose and insulin infusion versus Kayexalate Duration of hyperkalemia (hours) 26.4 +/- 14.9 (GI) and 38.6 +/- 13.3 (Kayexalate) Grade II and above intraventricular hemorrhage 15% (3/20) and 50% (10/20) Cardiac dysrhythmias 5% (1/20) and 10% (2/20) Hu PS et al 1999

7. Neonatal Hyperkalemia - Differential diagnosis • Acute and chronic renal failure • Adrenal insufficiency • Hyporeninemic hypoaldosteronism • Transcellular redistribution of K. • Acute tissue breakdown • Transfusion of red cells with high K levels. • Gordon syndrome • (hypertension with hyperkalemic acidosis)