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Life threatening hyperkalemia treated with prolonged continuous insulin infusion

Saif Awlad Thani1, Muzna Al Farsi1, Sara Al Omrani1

  • 1Royal Hospital, Muscat, Oman.

International Journal of Pediatrics & Adolescent Medicine
|November 9, 2019
PubMed

Insights

Severe hyperkalemia in an infant with Pseudohypoaldosteronism was refractory to standard treatments. Prolonged continuous insulin infusion effectively lowered potassium levels, avoiding dialysis.

Area of Science:

  • Pediatric Endocrinology
  • Nephrology
  • Critical Care Medicine

Background:

  • Hyperkalemia is a dangerous electrolyte imbalance requiring prompt treatment.
  • Pseudohypoaldosteronism can lead to severe, life-threatening hyperkalemia.
  • Standard anti-hyperkalemic medications may be insufficient in critical cases.

Observation:

  • A 4-month-old infant with Pseudohypoaldosteronism experienced cardiac arrest due to extreme hyperkalemia (12.3 mmol/L).
  • The infant's hyperkalemia was refractory to conventional anti-hyperkalemic therapies, necessitating transfer for dialysis.
  • Continuous insulin infusion with dextrose was initiated during transfer and for 12 hours post-transfer.

Findings:

  • Prolonged continuous insulin infusion gradually normalized the infant's potassium levels over 12 hours.
  • Dialysis was ultimately not required due to the effectiveness of the insulin infusion therapy.
  • This approach proved effective in managing life-threatening hyperkalemia.

Implications:

  • Continuous insulin infusion is a viable and effective treatment for severe, refractory hyperkalemia, particularly in pediatric cases.
  • This method offers a crucial alternative when dialysis services are unavailable or delayed.
  • Highlights the importance of considering prolonged insulin therapy in critical hyperkalemia management.

Keywords:
HyperkalemiaInfusionInsulin

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