A neonate who receives a blood transfusion may develop hyperkalemia.


Risk factors for hyperkalemia:

(1) premature infant

(2) hemolysis of blood prior to infusion (exposure of infusion tubing to a radiant warmer, exposure to incompatible solutions or drugs, infusion through too small a needle, etc.)

(3) hemolytic anemia

(4) acute tissue necrosis

(5) massive transfusion

(6) exchange transfusion

(7) acute renal insufficiency

(8) adrenal insufficiency

(9) acidosis

(10) excessive potassium administration

(11) transfusion of blood products near the outdate

(12) irradiation of blood product


Clinical findings:

(1) muscular weakness

(2) ileus

(3) cardiac arrhythmia (supraventricular tachycardia, bradycardia, other)

(4) ECG changes of hyperkalemia (peaking of T waves, decreased to absent P waves, prolonged PR interval, depression of the ST segment)

(5) serum potassium > 7 mmol/L


Differential diagnosis:

(1) hemolysis during or after serum collection with pseudohyperkalemia (repeat sample may be normal)


To read more or access our algorithms and calculators, please log in or register.