A complication to be aware of: hyperkalaemia following propranolol therapy for an infant with intestinal haemangiomatozis

Abstract

Infantile haemangiomas, benign vascular tumours seen in 4-10% of infants are characterised by their spontaneous remission following a 3-9 month period of dynamic growth. Propranolol has been reported to be used as a successful treatment of severe symptomatic infantile haemangiomas. Hyperkalaemia has not been recognised as a serious effect of propranolol since recently. Here, we would like to portray a 2-year-old male patient with intestinal haemangiomatosis who presented with severe hyperkalaemia and was successfully managed with hydration, loop diuretics, potassium binding granules, inhaler β-2 agonists and insulin. To date, this is the first case of intestinal haemangiomatosis complicated with severe hyperkalaemia. Our case suggested the idea of close monitorisation of potassium levels as well as haemodynamic status at the initialisation of the propranolol treatment.

Hyperkalemia Induced by the Sequential Administration of Metoprolol and Carvedilol

“…Propranolol has rarely been reported to induce hyperkalemia in the adult patient, though it is well documented as a serious problem when it is used to treat hemangiomas in infants [ 3 , 6 , 7 ].…”

A co-crystal of nonahydrated disodium(II) with mixed anions fromm-chlorobenzoic acid and furosemide

“…Furosemide is a widely used diuretic for the treatment of hypertension and edema (Krumlovsky & del Greco, 1976;Musini et al, 2015), and to a lesser extent, hypercalcemia (Belen et al, 2014;Carvalhana et al, 2006). While this furancontaining compound is of interest, the toxicity elicited by these core compounds is not well understood.…”

Retrospective case series of increased oral propranolol dosage for infantile hemangiomas

“…Many providers have thus continued to prescribe 2 mg/kg/d, per Léauté‐Labrèze's original report, given the known efficacy and to minimize the risk of rare but serious side effects associated with systemic beta‐blockers. Although no significant difference in side effects was observed between doses of 1 and 3 mg/kg/d in the propranolol RCT, serious adverse events including cardiac arrest, severe hyperkalemia, and hypoglycemic coma have been documented in case reports of 2 mg/kg/d dosing of propranolol for IH 4‐6 . As propranolol side effects are known to correlate with peak serum concentrations, it is expected that higher doses will increase this risk as supported by evidence from one study in adults 7,8 …”

“…Although no significant difference in side effects was observed between doses of 1 and 3 mg/ kg/d in the propranolol RCT, serious adverse events including cardiac arrest, severe hyperkalemia, and hypoglycemic coma have been documented in case reports of 2 mg/kg/d dosing of propranolol for IH. [4][5][6] As propranolol side effects are known to correlate with peak serum concentrations, it is expected that higher doses will increase this risk as supported by evidence from one study in adults. 7,8 Controversy also surrounds the potential benefit of increased dosing for the minority of patients with recalcitrant IH that fail to respond to 2 mg/kg/d of propranolol.…”