Management of hyperkalemia in children
- Michael J Somers, MD
Michael J Somers, MD
- Associate Professor of Pediatrics
- Harvard Medical School
Hyperkalemia is typically defined as a serum or plasma potassium greater than 5.5 mEq/L (mmol/L). However, the upper limit of normal in preterm infants and young infants may be as high as 6.5 mEq/L (mmol/L). Although children are less likely to develop hyperkalemia than adults, pediatric hyperkalemia is not an uncommon occurrence. Severe hyperkalemia (potassium level ≥7 mEq/L [mmol/L]) is a serious medical problem that requires immediate attention.
The management of hyperkalemia in children is reviewed here. The etiology, clinical findings, diagnosis, and evaluation of pediatric hyperkalemia are presented separately. (See "Causes, clinical manifestations, diagnosis, and evaluation of hyperkalemia in children".)
URGENCY OF THERAPY
The urgency of treatment of hyperkalemia varies with the level of extracellular (serum/plasma) potassium, the rapidity of the increase in potassium, and the presence of associated hyperkalemic-symptoms (algorithm 1).
The urgency and type of therapy are similar to that used in adults and are based on the severity of hyperkalemia and its potential to be life-threatening. (See "Treatment and prevention of hyperkalemia in adults", section on 'Determining the urgency of therapy'.)
●Initial emergent therapy is directed towards the patients who are at risk for life-threatening cardiac conduction disturbances due to hyperkalemia (table 1 and figure 1). The onset of action of emergent interventions is immediate (see "Causes, clinical manifestations, diagnosis, and evaluation of hyperkalemia in children", section on 'Cardiac conduction abnormalities' and 'Rapid measures to counteract adverse cardiac effects' below):To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Masilamani K, van der Voort J. The management of acute hyperkalaemia in neonates and children. Arch Dis Child 2012; 97:376.
- Winkler AW, Hoff HE, Smith PK. Factors affecting the toxicity of potassium. Am J Physiol 1939; 127:430.
- Helfrich E, de Vries TW, van Roon EN. Salbutamol for hyperkalaemia in children. Acta Paediatr 2001; 90:1213.
- Singh BS, Sadiq HF, Noguchi A, Keenan WJ. Efficacy of albuterol inhalation in treatment of hyperkalemia in premature neonates. J Pediatr 2002; 141:16.
- Lee J, Moffett BS. Treatment of pediatric hyperkalemia with sodium polystyrene sulfonate. Pediatr Nephrol 2016; 31:2113.
- Bomback AS, Woosley JT, Kshirsagar AV. Colonic necrosis due to sodium polystyrene sulfate (Kayexalate). Am J Emerg Med 2009; 27:753.e1.
- Mahoney BA, Smith WA, Lo DS, et al. Emergency interventions for hyperkalaemia. Cochrane Database Syst Rev 2005; :CD003235.
- URGENCY OF THERAPY
- OVERVIEW OF TREATMENT
- INITIAL EMERGENT THERAPY
- Rapid measures to counteract adverse cardiac effects
- - Calcium infusion
- - Insulin and glucose therapy
- - Other measures to shift extracellular K+
- Inhaled beta-adrenergic agonists
- Sodium bicarbonate
- - Monitoring response
- NON-EMERGENT THERAPY
- Clinical setting
- Treatment of reversible causes
- Therapies removing potassium from the body
- - Diuretics
- - Enteral cation exchange resins
- - Dialysis
- CHRONIC HYPERKALEMIA
- SUMMARY AND RECOMMENDATIONS