What is the best treatment for hyperkalaemia in a preterm infant?

A 720g neonate in the intensive care unit develops severe hyperkalaemia with cardiac arrhythmia. The Specialist registrar decides to give a Calcium Gluconate bolus and start an Insulin and Dextrose infusion. The new Registrar queries why Salbutamol and Ion Exchange resins were not considered as these therapies are frequently used in management of hyperkalaemia in older children and adults.

Clinical bottom line:

  • Insulin and dextrose infusion should form the first line of therapy in hyperkalaemia of the premature infant. [Grade A]
  • Oral and rectal ion exchange resins should be avoided as they are ineffective and associated with significant and potentially life threatening complications. [Grade A]
  • No substantial data show the superiority of salbutamol over insulin/dextrose for premature infants [Grade D]
  • Exchange transfusion may be used as a last resort therapy. [Grade D]

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Fiona Marie O’ Hare, Eleanor J Molloy, Department of Paediatrics, National Maternity Hospital, Dublin

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