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Treatment of hyperkalaemia
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| bet | 327/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Treatment of hyperkalaemia: A systematic review [3] of interventions for neonatal hyperkalaemia found 2 studies [4, 5] comparing insulin/glucose infusion versus rectal cation-resin. Meta-analysis of 2 studies (52 infants) found no difference in cardiac arrhythmias [RR 0.29; 95% CI 0.05, 1.65]; or all-cause mortality [RR 0.18; 0.03, 1.15]. Malone 1991, using an insulin infusion 0.05 to 0.2 units/kg/hour in albumin 5%, reported reduced treatment failure (rise in K+ concentration > 0.5 mmol/L or K+ > 7 mmol/L) of borderline statistical significance [RR 0.07; 0.00 to 1.01; RD -1.00; -1.28 to -0.72] compared to resin [5]. Hu 1999, using a glucose/insulin infusion with glucose 10–15 g:insulin 1 unit, reported a reduction in duration of hyperkalaemia [MD -12.20 hours; -20.95, -3.45]; no difference in peak serum K+ [MD -0.10 mmol/L; -0.57, 0.37]; a reduction in IVH [RR 0.3; 0.10, 0.93] and IVH grades ≥ 2 [RR 0.3; 0.10, 0.93] compared to resin; and no infant with hypoglycaemia in either group [4]. No study compared insulin-glucose with a beta-agonist. Conclusion: The combination of insulin and glucose is preferred over treatment with rectal cation-resin for hyperkalaemia in preterm infants [3]. (LOE I GOR C)
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