Pediatric Hyperkalemia Follow-up

  • Author: Michael J Verive, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 14, 2011
 

Further Inpatient Care

Hyperkalemia, by itself, is not a disease and is generally the result of diseases such as congenital adrenal hyperplasia, acute renal failure, rhabdomyolysis, or tumor lysis syndrome.

Following emergent management and stabilization of hyperkalemia, the patient should be hospitalized, and further workup should be initiated to determine the inciting cause and to prevent recurrence.

Next

Further Outpatient Care

Continuing care relates to the basic disease process that led to the hyperkalemia.

In patients with salt-wasting congenital adrenal hyperplasia, corticosteroid and mineralocorticoid supplementation are necessary.

Continued renal replacement therapy may be needed for patients with acute renal failure.

Patients with chronic mineralocorticoid deficiency require mineralocorticoid supplementation (eg, fludrocortisone).

Previous
Next

Transfer

Patients with acute life-threatening hyperkalemia should receive care in a pediatric or neonatal ICU capable of providing emergent hemodialysis.

Any child who develops hyperkalemia as a result of renal failure should be referred to a pediatric nephrologist for continuing care.

Previous
Next

Complications

If untreated, severe hyperkalemia can result in cardiac arrhythmia or death.

Treatment of pseudohyperkalemia may result in hypokalemia; thus, treatment of non–life-threatening hyperkalemia should be deferred pending verification of hyperkalemia.

Failure to determine and treat the underlying disease process causing hyperkalemia can predispose patients to recurrent, life-threatening hyperkalemia.

Previous
Next

Prognosis

Prognosis depends on the etiology.

Previous
Next

Patient Education

Teach patients to recognize the symptoms of hyperkalemia, such as palpitations, dizziness, and weakness.

Previous
 
Contributor Information and Disclosures
Author

Michael J Verive, MD  Medical Director, Pediatric Intensive Care, Department of Pediatrics, St Mary's Hospital for Women and Children

Michael J Verive, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, Pediatric Sedation, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

G Patricia Cantwell, MD  FCCM, Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD  Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

  1. Shaffer SG, Kilbride HW, Hayen LK, Meade VM, Warady BA. Hyperkalemia in very low birth weight infants. J Pediatr. Aug 1992;121(2):275-9. [Medline].

  2. Bhananker SM, Ramamoorthy C, Geiduschek JM, et al. Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg. Aug 2007;105(2):344-50. [Medline].

  3. Papaioannou V, Dragoumanis C, Theodorou V, Pneumatikos I. The propofol infusion 'syndrome' in intensive care unit: from pathophysiology to prophylaxis and treatment. Acta Anaesthesiol Belg. 2008;59(2):79-86. [Medline].

  4. Schweiger B, Moriarty MW, Cadnapaphornchai MA. Case report: severe neonatal hyperkalemia due to pseudohypoaldosteronism type 1. Curr Opin Pediatr. Apr 2009;21(2):269-71. [Medline].

  5. Mattu A, Brady WJ, Robinson DA. Electrocardiographic manifestations of hyperkalemia. Am J Emerg Med. Oct 2000;18(6):721-9. [Medline].

  6. Lorenz JM, Kleinman LI, Markarian K. Potassium metabolism in extremely low birth weight infants in the first week of life. J Pediatr. Jul 1997;131(1 Pt 1):81-6. [Medline].

  7. Schweiger B, Moriarty MW, Cadnapaphornchai MA. Case report: severe neonatal hyperkalemia due to pseudohypoaldosteronism type 1. Curr Opin Pediatr. Apr 2009;21(2):269-71. [Medline].

  8. Gurnaney H, Brown A, Litman RS. Malignant hyperthermia and muscular dystrophies. Anesth Analg. Oct 2009;109(4):1043-8. [Medline].

  9. Sánchez-Carpintero I, Ruiz-Rodriguez R, López-Gutiérrez JC. Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations. Actas Dermosifiliogr. Jul 18 2011;[Medline].

  10. Pavlakovic H, Kietz S, Lauerer P, Zutt M, Lakomek M. Hyperkalemia complicating propranolol treatment of an infantile hemangioma. Pediatrics. Dec 2010;126(6):e1589-93. [Medline].

  11. Cummings CC, McIvor ME. Fluoride-induced hyperkalemia: the role of Ca2+-dependent K+ channels. Am J Emerg Med. Jan 1988;6(1):1-3. [Medline].

  12. Suzuki H, Terai M, Hamada H, Honda T, Suenaga T, Takeuchi T, et al. Cyclosporin A treatment for Kawasaki disease refractory to initial and additional intravenous immunoglobulin. Pediatr Infect Dis J. Oct 2011;30(10):871-6. [Medline].

  13. Nowicki TS, Bjornard K, Kudlowitz D, Sandoval C, Jayabose S. Early recognition of renal toxicity of high-dose methotrexate therapy: a case report. J Pediatr Hematol Oncol. Dec 2008;30(12):950-2. [Medline].

  14. Piotrowski AJ, Fendler WM. Hyperkalemia and cardiac arrest following succinylcholine administration in a 16-year-old boy with acute nonlymphoblastic leukemia and sepsis. Pediatr Crit Care Med. Mar 2007;8(2):183-5. [Medline].

  15. [Guideline] Advanced life support. In: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation 2005 Nov 29;112(22 Suppl):III25-54. [Full Text].

  16. Bercovitz RS, Greffe BS, Hunger SP. Acute tumor lysis syndrome in a 7-month-old with hepatoblastoma. Curr Opin Pediatr. Nov 18 2009;[Medline].

  17. Behrman R, Kliegman R, Jenson H. Nelson Textbook of Pediatrics. 17th Ed. Philadelphia, PA: WB Saunders; 2004.

  18. Brenner B. Brenner & Rector's The Kidney. 7th ed. St Louis, MO: WB Saunders; 2004.

  19. Finberg L, Kravath R, Hellerstein S. Potassium. In: Water and Electrolytes in Pediatrics: Physiology, Pathophysiology, and Treatment. Philadelphia, PA: WB Saunders; 1993:70-1.

  20. Goldfrank LR, ed. Goldfrank's Toxicologic Emergencies. 6th ed. Stanford, CT: Appleton & Lange; 1998.

  21. Kokko, JP, Tannen RL. Potassium disorders. In: Fluids and Electrolytes. Philadelphia, PA: WB Saunders; 1990:195-300.

  22. Lieh-Lai, M, Asi-Bautista, M, Ling-McGeorge, K. Hyperkalemia. In: Pediatric Acute Care Handbook. Philadelphia, PA: Lippincott, Williams, & Wilkins; 1995.

  23. Maxwell MH, Kleeman CR. Maxwell and Kleeman's Clinical Disorders of Fluid and Electrolyte Metabolism. 5th Ed. New York, NY: McGraw-Hill; 1994.

  24. Odegard KC, DiNardo JA, Kussman BD, et al. The frequency of anesthesia-related cardiac arrests in patients with congenital heart disease undergoing cardiac surgery. Anesth Analg. Aug 2007;105(2):335-43. [Medline].

 
Previous
Next
 
Peaked T waves.
Sinusoidal wave.
Hyperkalemia diagnosis and treatment flow chart.
Table. Select Factors Affecting Plasma Potassium
Factor Effect on Plasma K+Mechanism
AldosteroneDecreaseIncreases sodium resorption, and increases K+ excretion
InsulinDecreaseStimulates K+ entry into cells by increasing sodium efflux (energy-dependent process)
Beta-adrenergic agentsDecreaseIncreases skeletal muscle uptake of K+
Alpha-adrenergic agentsIncreaseImpairs cellular K+ uptake
Acidosis (decreased pH)IncreaseImpairs cellular K+ uptake
Alkalosis (increased pH)DecreaseEnhances cellular K+ uptake
Cell damageIncreaseIntracellular K+ release
SuccinylcholineIncreaseCell membrane depolarization
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.