lecture Tokushima University Hospital Tokushima, Tokushima, Japan
Background: Non-oliguric hyperkalemia (NOHK) is a severe, potentially life-threatening condition in extremely low birth weight infants (ELBWI) due to its impact on cardiac rhythm. Hypoglycemia associated with glucose-insulin therapy for NOHK and delayed administration of Cox inhibitors for patent ductus arteriosus are often experienced in ELBWI clinical practice. It is postulated that early administration of sodium and amino acids may reduce the risk of NOHK in ELBWI by increasing potassium excretion in the distal tubule, and by mitigating the suppression of insulin secretion resulting from hypercatabolism, respectively. Objective: To assess the prophylactic effect of early parenteral sodium(P_Na) and amino acid (P_AA) on NOHK in ELBWI. Design/Methods: We conducted a single-center, retrospective cohort study on ELBWI born between 1999 and 2022. From 2004, our Neonatal Intensive Care Unit (NICU) implemented the practice of initiating P_Na at a dose of 2-4 mEq/kg/day within hours after birth, with discontinuation if serum sodium levels exceeded 145 mEq/L. P_AA were introduced in our NICU practice from 2011. Peak potassium (K+) levels during the first 72 hours of life were recorded, and NOHK was defined as K+ > 6.5 mEq/l with urine output ≥1 ml/kg/h. Results: Our study included 242 ELBWI, of which 45 experienced NOHK, while 197 did not. The median time for peak K+ levels in the NOHK group was 19 hours of life (IQR 14-27). The incidence of NOHK was notably high between 1999 and 2003, with most patients requiring glucose-insulin therapy, either as treatment or prophylaxis (Figure 1). Following the initiation of P_Na in 2004, the incidence of NOHK decreased, and the need for glucose-insulin therapy was eliminated after 2008. The introduction of P_AA in 2011 further reduced the incidence of NOHK, eventually stabilizing at zero from 2018 onwards. P_Na is significantly lower in NOHK (median 0.0 mEql/kg/day [IQR 0-2.9] ) than in that in non-NOHK (3.0 mEql/kg/day [IQR 2.4-3.3] ) (p < 0.001), and P_AA is also significantly lower in non-NOHK (median 0 q/kg/day [0-0] than NOHK (2.1 [0-2.5]) (p < 0.0001)(Table 1). Multivariate analysis revealed that the risk of NOHK was significantly decreased with P_Na (adjusted odds ratio [aOR] 0.68, 95% confidence interval [CI] 0.49-0.89, p< 0.01) and P_AA (aOR 0.36; 95% CI 0.20–0.61, p< 0.0001), respectively (Table2).
Conclusion(s): This retrospective study suggests that early administration of sodium and amino acids have a prophylactic effect on the development of NOHK in ELBWI. Further investigation through randomized controlled studies is warranted to validate this novel strategy. Figure 1.001.jpeg
