Health & Medical Children & Kid Health

Management of Acute Hyperkalaemia in Neonates and Children

´╗┐Management of Acute Hyperkalaemia in Neonates and Children

Case 2

A 22-month-old girl presented to hospital with a 5-day history of generalised oedema and oliguria. She had been fit and well apart from a preceding viral illness. There was no history of diarrhoea. On admission she was found to be weak and profoundly hypertensive (160/100 mm Hg), oedematous and pale with minimal urine output (0.4 ml/kg/h). The results of her blood investigations are given in Table 2.

Initial management of hyperkalaemia included intravenous calcium gluconate, nebulised salbutamol, oral calcium resonium, intravenous sodium bicarbonate and an insulin and glucose infusion. Her hypertension was managed with frusemide, labetalol and hydralazine infusions. The potassium fell to 6.9 mmol/l and her blood pressure reduced to 140/100 mm Hg, but the haemoglobin fell further to 5.9 g/dl. A haemodialysis line was inserted without a blood transfusion due to the risk of further hyperkalaemia and hypertension. Haemodialysis was commenced, with a concomitant blood transfusion, allowing for simultaneous potassium and fluid removal. Further investigations showed low complement levels (C3 and C4), elevated lactic dehydrogenase and reticulocyte count and a further drop in platelet count, confirming a diagnosis of atypical haemolytic uraemic syndrome (HUS). Renal function recovered completely after a period of haemodialysis and plasma exchange.

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