Nephrology Approach to child with hyperkalemia

Approach to child with hyperkalemia Hyperkalemia is typically defined as a serum or plasma potassium greater than ۵.۵ mEq/L (mmol/L). However, the upper limit of normal in preterm infants and young infants may be as high as ۶.۵ mEq/L (mmol/L). Severe hyperkalemia (potassium level ۷ mEq/L [mmol/L]) is a serious medical problem that requires immediate attention. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Symptoms usually develop at higher levels, ۶.۵ mEq/L to ۷ mEq/L, but the rate of change is more important than the numerical value. Although it is rare to get arrhythmias if the K+ is below ۷.۵ mmol/L, treatment should be given at lower values if there are ECG changes. Serial changes are as follows as the potassium level increases: ۱. Peaked T waves ۲. ST segment depression ۳. Increased PR interval ۴. Flattened P wave ۵. Widened QRS complex ۶. Ventricular fibrillation (VF) ۷. Asystole. Management: ۱-Exogenous sources of potassium should be immediately discontinued. ۲. Calcium therapy will stabilize the cardiac response to hyperkalemia and should be initiated first in the setting of cardiac toxicity. Calcium does not alter the serum concentration of potassium. Calcium chloride contains three times more elemental calcium than calcium gluconate but is more irritating to peripheral vessels, So, maybe cause tissue necrosis with extravasation, so it is usually only given through central venous lines. Thus, calcium gluconate is the usual initial drug of choice in patients with evidence of cardiac toxicity. Intracellular potassium shift-۳ Beta-۲ adrenergic agents such as albuterol will also shift potassium intracellularly. Sodium bicarbonate infusion may be helpful in patients with metabolic acidosis. Sodium bicarbonate ۱--۲ mEq/kg (max: ۵۰ mEq) Intravenous Insulin and glucose, or insulin alone in hyperglycemic patients, will shift the potassium into the cells, effectively lowering serum potassium. D/W۵% ۱cc/kg and ۰.۱u/kg regular insulin. Decrease in total body potassium load-۴ Furosemide ۰.۵--۱ mg/kg (max: ۴۰ mg) Intravenous Sodium polystyrene sulfonate ۱ g/kg (max: ۳۰ g oral, ۳۰--۵۰ g rectal) Oral, rectal Fludrocortisone (in mineralocorticoid deficiency) ۰.۰۵--۰.۲ mg/day, one to two divided doses Oral ۵- Hemodialysis should be performed in patients with end-stage renal disease or severe renal impairment. Conclusion: Hyperkalemia is an electrolyte abnormality in which serum potassium level exceeds the normal range for age and can cause life-threatening complications.