Severe Hyperkalemia Immediately After Birth

Abstract

Patient: Male, newbornFinal Diagnosis: HyperkalemiaSymptoms: Respiratory distress • ventricular tachycardiaMedication: —Clinical Procedure: Exchange transfusionSpecialty: Pediatrics and NeonatologyObjective:Unknown ethiologyBackground:Hyperkalemia is an important cause of arrhythmias and a medical emergency that requires urgent treatment. The etiology is usually multifactorial. It is most frequently caused by impaired potassium secretion, followed by transcellular potassium shifts and an increased potassium load.Case Report:A male newborn developed monomorphic ventricular tachycardia 2 hours after birth. He was born in the 35th week of gestation by urgent C-section following placental abruption. Laboratory results showed hemolytic anemia (Hb 99 g/L, Hct 0.31) with increased bilirubin levels and reticulocytosis, thrombocytopenia (39×109/L), hypoglycemia (0.8 mmol/L), and severe hyperkalemia (9.8 mmol/L). Umbilical artery blood gas analysis showed hypoxemia with acidosis (pO2 3.8 kPa, pH 7.21, pCO2 7.84 kPa, HCO3 23.3 mmol/L, BE –5 mmol/L). Creatinine (102 µmol/L) and urea (9.8 mmol/L) were mildly elevated. Inflammatory markers were also increased (CRP 26 mg/L, blood leukocyte count 24×109/L). Early-onset sepsis, caused by Candida albicans, was confirmed approximately 24 hours after birth. Non-invasive ventilation with 35–40% O2 was necessary due to transient tachypnea. The neonate received a transfusion of packed red blood cells, a 10% glucose infusion, and empirical antibiotic therapy. Hyperkalemia accompanied by arrhythmias was treated with calcium gluconate, insulin, Sorbisterit enema, and, finally, by exchange transfusion.Conclusions:We report a case of severe hyperkalemia in a newborn immediately after birth. Making a decision as early as possible regarding exchange transfusion is essential in patients with hyperkalemia with electrocardiogram changes and hemodynamic instability.

Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients

“…A number of clinical case reports have documented TAHCA in patients receiving large volume transfusions, although we have also highlighted reports of TAHCA following rapid, small volume transfusions of older and/or irradiated blood products (66,67,82,84,88,89,91). Inoue et al, observed peaked T-waves immediately after administering 10 mL of blood via handheld syringe to a 1.4kg newborn (82).…”

“…Nevertheless, hyperkalemia from blood transfusion is the second most common cause of perioperative cardiac arrest in neonates, infants, and children as documented by the perioperative cardiac arrest registry, second only to hypovolemia from blood loss (74). In Table 1, we have summarized 24 case studies and reports of TAHCA in neonatal, infant, and pediatric patients -with data reported as indicated in the original article (25,37,39,40,66,67,71,(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92). We also highlight a case report in which TAHCA was avoided by pre-transfusion K + filtration (87).…”