Continuous arteriovenous hemofiltration as emergency procedure in severe hyperkalemia

Area of Science:

• Neonatal Medicine
• Pediatric Nephrology
• Critical Care Medicine

Background:

• Infants of diabetic mothers are at increased risk for complications, including acute renal failure.
• Severe hyperkalemia (elevated serum potassium) is a life-threatening condition in neonates, potentially leading to cardiac arrhythmias.
• Standard medical management for hyperkalemia may be insufficient in cases of acute renal failure.

Observation:

• A preterm infant born to a diabetic mother developed severe hyperkalemia secondary to acute renal failure.
• Despite conventional treatments (calcium gluconate, sodium bicarbonate, glucose, insulin), serum potassium levels continued to rise, leading to ventricular flutter.
• The infant required cardiac resuscitation following the ventricular arrhythmia.

Findings:

• Continuous arteriovenous hemofiltration (CAVH), a type of extracorporeal renal replacement therapy, was initiated for potassium elimination.
• Within 3 hours of initiating CAVH, serum potassium levels decreased significantly from 9.4 mEq/l to below 7 mEq/l.
• CAVH was continued for 60 hours due to persistent oliguria, facilitating fluid and electrolyte balance.

Implications:

• Continuous arteriovenous hemofiltration is an effective therapeutic option for managing severe, refractory hyperkalemia in neonates with acute renal failure.
• Extracorporeal renal replacement therapy can rapidly correct life-threatening electrolyte imbalances in critically ill infants.
• This case highlights the importance of considering advanced renal replacement therapies in neonatal critical care for severe metabolic disturbances.