From the Guidelines
Hyperkalemia in a newborn is primarily caused by impaired renal function, excessive potassium intake, cellular release of potassium, or pseudohyperkalemia, with immature kidney function in premature infants being a significant risk factor, as noted in the 2018 Clinical Nutrition study 1. The causes of hyperkalemia in newborns can be multifaceted, involving various factors that affect potassium levels in the body. Some of the key causes include:
- Impaired renal function, which can be particularly problematic in premature infants due to their immature kidneys, as discussed in the 2018 Clinical Nutrition study 1
- Excessive potassium intake through IV fluids, medications, or blood transfusions, which can overwhelm the newborn's excretion capacity
- Cellular release of potassium due to birth trauma, asphyxia, severe hemolysis, or intraventricular hemorrhage, releasing intracellular potassium into the bloodstream
- Endocrine disorders like congenital adrenal hyperplasia or adrenal insufficiency, which reduce aldosterone production and impair potassium excretion
- Medications given to the mother or infant, including potassium-sparing diuretics, ACE inhibitors, or NSAIDs, which can contribute to hyperkalemia
- Pseudohyperkalemia, which may occur from improper blood collection techniques causing hemolysis
According to the 2018 Clinical Nutrition study 1, hyperkalemia can occur with or without impaired renal K excretion, and early hyperkalemia can develop in the absence of oliguria and potassium intake. The study also notes that non-oliguric hyperkalemia (NOHK) should be checked for after birth in VLBWI at risk, and that severe hyperkalemia requires prompt intervention. Key points to consider in managing hyperkalemia in newborns include:
- Immediate ECG monitoring to assess cardiac function
- Calcium gluconate for cardiac protection
- Insulin with glucose to help lower potassium levels
- Sodium bicarbonate for acidosis
- Diuretics like furosemide to enhance potassium excretion
- Prevention involves careful monitoring of potassium levels, especially in premature infants or those with risk factors, as emphasized in the 2018 Clinical Nutrition study 1.
From the Research
Causes of Hyperkalemia in Newborns
- Hyperkalemia in newborns can be caused by various factors, including impaired potassium secretion, transcellular potassium shifts, and increased potassium load 2
- Renal dysfunction, metabolic acidosis, and catabolic state can contribute to the development of hyperkalemia in newborns, particularly in those who are sick or premature 3
- Other potential causes of hyperkalemia in newborns include:
- Hemolysis, as seen in cases of hemolytic anemia 2
- Infection, such as early-onset sepsis caused by Candida albicans 2
- Medications, although this is not specifically mentioned in the context of newborns 4, 5
- Rhabdomyolysis, which can occur in newborns with perinatal asphyxia or other conditions 5
- Aldosterone deficiency, which can affect potassium levels in the body 5
Specific Factors in Premature Infants
- Premature infants are at higher risk of developing hyperkalemia due to their immature renal function and higher susceptibility to metabolic acidosis and catabolic states 3
- Factors that contribute to hyperkalemia in premature infants include:
- Low birth weight (less than 2000g) 3
- Decreased calorie intake, which can exacerbate catabolism and increase potassium release from cells 3
- Decreased urine volume and creatinine clearance, indicating impaired renal function 3
- Metabolic acidosis, which can occur in premature infants due to various factors, including respiratory distress and infection 3