title: Life-threatening hyperkalemia following partial pancreatectomy for neonatal hyperinsulinism.
abstract: OBJECTIVE
  To alert readers to the possibility of rebound hyperkalemia following pancreatic resection for neonatal hyperinsulinism.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Intensive care unit of tertiary pediatric hospital.
  
  
  METHODS
  A term neonate with severe hyperinsulinism complicated by hypokalemia, fluid overload, and necrotizing enterocolitis.
  
  
  METHODS
  Preoperative management consisted of glucose 20.8 mg/kg/min, diazoxide 15 mg/kg/day, octreotide 27 mug/kg/day, and potassium (>10 mmol/kg/day) to maintain normoglycemia and normokalemia. The large glucose requirement, administered as 20% glucose, contributed to congestive heart failure, which was treated with frusemide. Attempts to feed enterally were abandoned because of necrotizing enterocolitis. Partial colectomy and subtotal pancreatectomy were performed on day 20.
  
  
  RESULTS
  Serum potassium rose rapidly within 2 hrs of surgery to reach 12.3 mmol/L, causing ventricular tachycardia (240 beats/min) on electrocardiogram. There was no evidence of renal failure or adrenal insufficiency. Management consisted of insulin 0.1 units/kg intravenously, 10% calcium gluconate 0.1 mmol/kg intravenously, sodium bicarbonate 3 mmol/kg intravenously, frusemide 2 mg/kg intravenously, and resonium 0.6 g/kg per rectum with good outcome.
  
  
  CONCLUSIONS
  This report highlights the rapid electrolyte shifts possible after sudden cessation of hormones regulating Na/K-ATPase activity.
authors.affiliation: Department of Anaesthesia, Starship Hospital, Auckland, New Zealand.
authors.forename: James D
authors.initials: JD
authors.lastname: Austin
authors.forename: Paul
authors.initials: P
authors.lastname: Hofman
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Anderson
mesh_terms: D004562:Electrocardiography; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications / Q000601:surgery*; D006947:Hyperkalemia / Q000209:etiology* / Q000503:physiopathology; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery*; D008297:Male; D010180:Pancreatectomy / Q000379:methods*; D011183:Postoperative Complications; D016896:Treatment Outcome