Potassium metabolism in extremely low birth weight infants in the first week of life☆,☆☆
Section snippets
Methods
The study protocol was approved by the institutional review board of the State University of New York at Stony Brook. Infants with appropriate size for gestational age and birth weight of 1000 gm or less were enrolled in the study as soon after birth as informed parental consent could be obtained. Infants with congenital heart disease, renal failure, or major congenital anomalies and infants more than 24 hours of age or who had received more than 20 ml/kg of blood products before enrollment
Results
Thirty-two infants appropriate in size for gestational age, with birth weight of 1000 gm or less, were enrolled in the study. After enrollment, one infant had acute renal failure with hyperkalemia and was excluded from these results. Birth weights of the remaining 31 infants ranged from 539 to 1000 gm, with a mean (±SD) of 818 ± 128 gm. Gestational age ranged from 23 to 30 weeks, with a mean (±SD) of 26 ± 1 weeks.
Mean PKs are depicted as a function of age for the entire group in Fig. 1 .
. Mean
Discussion
Our findings characterized the first 1 to 3 days of life in ELBW infants as a period of unique vulnerability to hyperkalemia, even in the absence of factors otherwise known to predispose infants to this life-threatening electrolyte imbalance. This is the result of at least two phenomena. The first is a shift of potassium from the intracellular to the extracellular space. The increase in PK observed in the first day of life in most of our subjects, in the absence of exogenous potassium
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Cited by (74)
Fluid management considerations in extremely preterm infants born at 22-24 weeks of gestation
2022, Seminars in PerinatologyCitation Excerpt :This knowledge should help guide decisions regarding the need for providing adequate sodium intake for this population. Plasma potassium concentration is higher in preterm than in term neonates, and it typically falls in the first few days of life.46 Non-oliguric hyperkalemia may be seen in very low birth weight infants in the first 48 hours after birth despite minimal potassium intake, likely resulting from an intracellular to extracellular potassium shift.47
Parenteral nutrition for preterm infants: Issues and strategy
2018, Archives de PediatrieCitation Excerpt :The intracellular concentration ranges between 100 and 150 mmol/L between tissues, whereas potassium concentration in the extracellular compartment is 4.5 mmol/L. Tissue catabolism representing 1% of body cell mass transfers approximately 2.5 mmol of potassium to the extracellular sector. Thus, kalemia reflects not only (1) potassium intake but also (2) potassium flux from the intracellular to the extracellular compartment (attrition, catabolism), which increases serum potassium, (3) the passage of ions from the extracellular to the intracellular compartment (anabolism), and (4) urinary potassium loss and potassium secretion into intestinal lumen, which lower serum potassium [118]. PN with higher and earlier amino acid and energy intake will tend to lower serum potassium, avoid nonoliguric hyperkalemia, and above all improve the potassium balance [119].
Acute kidney injury in the fetus and neonate
2017, Seminars in Fetal and Neonatal MedicineCitation Excerpt :The peritubular and luminal permeability of potassium may be contributing to the physiologic positive balance. In premature infants immediately following birth, there is a shift of potassium from the intracellular to the extracellular compartment [11]. Once the kidney adapts to the extrauterine environment, there is the onset of diuresis which facilitates potassium excretion and the regulation of serum potassium levels.
Factors Regulating the External Balance of Potassium
2017, Fetal and Neonatal Physiology, 2-Volume SetNeonatal renal physiology
2013, Seminars in Pediatric SurgeryCitation Excerpt :A major determinant of potassium balance is cellular metabolism. In the premature infants, immediately following birth, there is a shift of potassium from the intracellular to the extracellular compartment.25 Once the kidney adapts to the extrauterine environment, there is the onset of diuresis that facilitates potassium excretion and the regulation of serum potassium levels.
Potassium Metabolism
2012, Nephrology and Fluid/Electrolyte Physiology: Neonatology Questions and Controversies Expert Consult
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