Safety and efficacy of two potassium cocktail formulations for treatment of neonatal hyperkalemia.
BACKGROUND
A consensus has not been established for the standard treatment of hyperkalemia in the neonatal population. Most treatment regimens include a dextrose/insulin infusion. Additional agents used include calcium, sodium bicarbonate, polystyrene sulfonate, and albuterol. This study assessed the safety and efficacy of a potassium cocktail (k-cocktail) containing dextrose, insulin, calcium gluconate, and sodium lactate for treatment of neonatal hyperkalemia.


OBJECTIVE
To determine whether modifications to a potassium cocktail formulation, based on a prior quality improvement project, resulted in a decrease in the incidence of hyperglycemia and acidosis associated with its use, and to evaluate the effectiveness of the k-cocktail in lowering serum potassium levels and the incidence of adverse effects.


METHODS
We conducted a retrospective cohort study of neonates with hyper-kalemia who received 2 k-cocktail formulations (group 1 [n = 13], original formulation, dextrose:insulin 5:1; group 2 [n = 26], modified formulation, dextrose: insulin 3.3:1). Group 2 subjects were matched 2:1 by gestational age and birth weight with those in group 1. Variables related to safety and effectiveness of therapy were assessed by medical record review. The following tests were used to assess group differences: χ(2), Fisher exact, 2-tailed t-tests, and mixed linear models.


RESULTS
The incidence of hyperglycemia during the modified k-cocktail infusion in group 2 decreased from 76.9% to 21.7% (p = 0.001). Serum blood glucose concentrations increased during the infusion, on average, for group 1 infants and were unchanged during the infusion for those in group 2. The incidence of acidosis during the infusion was similar between groups (group 1 [76.9%] vs group 2 [68.2%]; p = 0.58). No significant adverse events were observed. Serum potassium concentrations decreased similarly in both groups.


CONCLUSIONS
An intravenous infusion including a dextrose:insulin ratio of 3.3:1, compared with a higher ratio, results in less hyperglycemia and appears to be as effective in decreasing potassium concentrations in newborns.
Neonatal Intensive Care Unit, Children's Mercy Hospital and Clinics, Kansas City, MO, USA. aoschman@cmh.edu
Alexandra
A
Oschman
Amanda
A
Gansen
Howard
H
Kilbride
Tracy
T
Sandritter
D000138:Acidosis / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control; D001786:Blood Glucose / Q000378:metabolism; D002125:Calcium Gluconate / Q000008:administration & dosage; D015331:Cohort Studies; D004359:Drug Therapy, Combination / Q000379:methods; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control; D006947:Hyperkalemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007223:Infant; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage; D008499:Medical Records; D017680:Potassium Compounds / Q000008:administration & dosage*; D012189:Retrospective Studies; D019354:Sodium Lactate / Q000008:administration & dosage; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin; D017680:Potassium Compounds; D005947:Glucose; D002125:Calcium Gluconate; D019354:Sodium Lactate