Prophylactic Calcium Administration for Hyperkalemia in Extremely Low Birthweight Infants

ABSTRACT

The objective of this study was to clarify the relationship between the blood potassium and calcium levels, and the efficacy of prophylactic calcium (Ca) administration early in life for nonoliguric hyperkalemia in extremely low birthweight (ELBW) infants. This was a retrospective study including 55 ELBW infants with gestational age less than 26 weeks (mean, 24.4 weeks; mean body weight, 681 g). The plasma potassium concentration and whole blood ionized calcium (iCa) concentration were measured every 2 to 3 hours. Laboratory data obtained up to 24 hours after birth were collected. The infants were divided into two groups based on whether or not Ca gluconate was administered prophylactically starting at admission (prophylactic and nonprophylactic group). There was a negative correlation between the plasma potassium and iCa levels at 12 and 24 hours, and the maximum plasma potassium level was higher in the hypocalcemia group (minimum iCa level, < 0.9 mmol/L) than in the normocalcemia group. The iCa level was significantly higher and the plasma potassium level was significantly lower in the prophylactic group than in the nonprophylactic group at 12 and 24 hours. The increment in the plasma potassium level at 24 hours compared with that at admission was significantly lower in the prophylactic than in the nonprophylactic group. Nonoliguric hyperkalemia may be attenuated by maintaining the iCa level within normal limits by prophylactic Ca administration early in life. Prospective studies are needed to confirm this.

KEYWORDS

Extremely low birthweight infants - hyperkalemia - ionized calcium concentration - calcium administration

REFERENCES

• 1 Pincus J, Gittleman I F, Saito M. A study of plasma values of sodium, potassium, chloride, carbon dioxide, carbon dioxide tensin, sugar, urea, and the protein basebinding power, pH and hematocrit in prematures on the first day of life.  Pediatrics. 1956;  18 39-49
• 2 Usher R H. The respiratory distress syndrome of prematurity: I. Changes in potassium in the serum and the electrocardiogram and effects of therapy.  Pediatrics. 1959;  24 562-576
• 3 Leslie G I, Carman G, Arnold J D. Early neonatal hyperkalemia in the extremely premature newborn infant.  J Paediatr Child Health. 1990;  26 58-61
• 4 Gruskay J, Costarino A T, Polin R A, Baumgart S. Nonoliguric hyperkalemia in the premature infant weighing less than 1000 grams.  J Pediatr. 1988;  113 381-386
• 5 Kilbride H W, Cater G, Warady B A. Early onset hyperkalemia in extremely low birth weight infants.  J Perinatol. 1988;  8 211-214
• 6 Lui K, Thungappa U, Nair A, John E. Treatment with hypertonic dextrose and insulin in severe hyperkalemia of immature infants.  Acta Paediatr. 1992;  81 213-216
• 7 Fukuda Y, Kojima T, Ono A, Matsuzaki S, Iwase S, Kobayashi Y. Factors causing hyperkalemia in premature infants.  Am J Perinatol. 1989;  6 76-79
• 8 Bergstein J M. Renal failure. In: Behrman RE, Klingman RM Nelson Textbook of Pediatrics, 16th ed. Philadelphia; WB Saunders Co. 2000: 1605-1609
• 9 Briton L P, Satlin L M, Edelmann Jr C M. Renal disease. In: Avery GB, Fletcher MA, MacDonald MG Neonatology: Pathophysiology and Management of the Newborn, 5th ed. Philadelphia; Wolters Kluwer Co. 1999: 887-973
• 10 Shortland D, Trounce J Q, Levene M I. Hyperkalemia, cardiac arrhythmias, and cerebral lesions in high risk neonates.  Arch Dis Child. 1987;  62 1139-1143
• 11 Edvinsson L, Lou H C, Tvede K. On the pathogenesis of regional cerebral ischemia in intracranial hemorrhage: a causal influence of potassium.  Pediatr Res. 1986;  20 478-480
• 12 Schwartz A B. Potassium-related cardiac arrhythmias and their treatment.  Angiology. 1978;  29 194-205
• 13 Venkataraman P S, Blick K E, Fry H D, Rao R K. Postnatal changes in calcium-regulating hormones in very-low-birth-weight infants.  Am J Dis Child. 1985;  139 913-916
• 14 Tsang R C, Light I J, Sutherland J M, Kleinman L I. Possible pathogenetic factors in neonatal hypocalcemia of prematurity.  J Pediatr. 1973;  82 423-429
• 15 Nervez C T, Shott R J, Bergstrom W H, Williams M L. Prophylaxis against hypocalcemia in low-birth-weight infants requiring bicarbonate infusion.  J Pediatr. 1975;  87 439-442
• 16 Venkataraman P S, Wilson D A, Sheldon R E, Rao R, Parker M K. Effect of hypocalcemia on cardiac function in very-low-birth-weight preterm neonates: studies of blood ionized calcium, echocardiography, and cardiac effect of intravenous calcium therapy.  Pediatrics. 1985;  76 543-550
• 17 Bisogno J L, Langley A, Von Dreele M M. Effect of calcium to reverse the electrocardiographic effects of hyperkalemia in the isolated rat heart: a prospective, dose-response study.  Crit Care Med. 1994;  22 697-704
• 18 Kunis C L, Lowenstein J. The emergency treatment of hyperkalemia.  Med Clin North Am. 1981;  65 165-176