Related Experiment Videos
Treatment with hypertonic dextrose and insulin in severe hyperkalaemia of immature infants
1Department of Paediatrics, Westmead Hospital, New South Wales, Australia.
Insights
Dextrose/insulin infusions effectively treated severe hyperkalaemia in preterm infants, lowering potassium levels within hours. However, managing associated hyperglycemia posed a significant challenge, with two infants experiencing fatal rebound hyperkalaemia.
Area of Science:
- Neonatalogy
- Pediatric Endocrinology
- Intensive Care Medicine
Background:
- Severe hyperkalaemia is a critical condition in preterm infants.
- Preterm infants born between 24-26 weeks gestation are at high risk.
- Cardiac arrhythmias are a common complication of hyperkalaemia.
Purpose of the Study:
- To evaluate the efficacy and safety of dextrose/insulin infusions for treating severe hyperkalaemia in extremely preterm infants.
- To assess the management of associated hyperglycemia during treatment.
- To identify potential complications and outcomes.
Main Methods:
- A retrospective review of 12 extremely preterm infants (24-26 weeks gestation) with severe hyperkalaemia (serum potassium 7.4-8.4 mmol/l).
- Infants received dextrose/insulin infusions starting within 24 hours of birth.
- Treatment efficacy, potassium levels, glucose control, and adverse events were monitored.
Main Results:
- All infants showed an initial decrease in serum potassium below 6.5 mmol/l within 5 hours.
- Hyperglycemia was a major challenge, requiring careful insulin titration.
- Two infants experienced rebound hyperkalaemia, with one mortality; 10 infants survived.
Conclusions:
- Dextrose/insulin infusions are effective in rapidly lowering potassium in preterm infants with hyperkalaemia.
- Hyperglycemia management is crucial and can be challenging during treatment.
- While effective, the treatment carries risks, including rebound hyperkalaemia and mortality.
Abstract:
Over a three-year period, 12 infants received dextrose/insulin infusions for severe hyperkalaemia from a mean age of 24 h. The infants were born after 24 to 26 weeks of gestation and weighed 730 +/- 172 g (mean +/- SD) at birth. Serum potassium concentration ranged from 7.4 to 8.4 mmol/l (7.7 +/- 0.4 mmol/l; mean +/- SD). Four had cardiac arrhythmias. All infants showed an initial response, serum potassium concentration decreased below 6.5 mmol/l in 5 +/- 2 h. In two infants, rebound hyperkalaemia occurred and was resistant to treatment; both infants died, one during an exchange transfusion. In the other 10 infants, infusions were ceased at a mean postnatal age of 53 h. Hyperglycaemia was the major problem during infusion and was resistant to increases in insulin concentrations. Normoglycaemia was achieved in 10 infants. The hypertonic solution consisted of a dextrose/insulin ratio of 2.2 +/- 0.6 g/IU, which delivered glucose at a rate of 0.46 +/- 0.15 g/kg/h, in addition to the pre-existing stable maintenance glucose intake.