Hiperkalemia Pada Pediatrik&Hirchprung Disease

8/17/2019 Hiperkalemia Pada Pediatrik&Hirchprung Disease

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Hiperkalemia pada

pediatrik


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Hyperkalemia is generally due to one or acombination of the following mechanisms:

• Excessive increase in potassium intake

• Transcellular movement of intracellular potassiuminto the extracellular space (eg, rhabdomyolysisfrom crush injury or exercise, tumor lysis

syndrome, massive transfusion, and metabolicacidosis

• !ecreased renal excretion of potassium (impairede"ective arterial perfusion, renal dysfunction, or

hypoaldosteronism


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• cardiac status (rate and rhythmdetermines the care of children withhyperkalemia

• #n children with hyperkalemia, theappearance of peaked T waves is

followed by lengthening of the $%interval and widening of the &%'complex until $ waves are lost

• inally, the &%' complex mergeswith its T wave to produce asinusoidal pattern


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Treatment

• Emergent therapy is -rst directed toward

antagonism of potassium.s cardiac e"ects byadministration of calcium

• 'erum potassium is then reduced by returningpotassium to the intracellular space by correcting

acidosis through administration of sodiumbicarbonate (/0* mE12kg

• To maintain potassium in the intracellular space,glucose and insulin are administered by infusion

(+340/ g2kg glucose with +3/ 52kg insulin over 6+07+ minutes3

)ote, *++


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Cardiac membrane stabilization

• )alcium directly antagoni9es the hyperkalemia0induced

depolari9ation of the resting cardiac membrane• )alcium therapy results in decreased membrane

excitability and reduces the risk of developing cardiacconduction abnormalities and arrhythmias 3

• #t should be given only for hyperkalemia with

signi-cant E) -ndings (eg, widening of the &%'complex or loss of $ waves, but not peaked T wavesalone, with severe arrhythmias thought to be causedby hyperkalemia or in patients with a potassium levelgreater than ; mE12<

• #n children, calcium gluconate /+ percent solution isgiven at a dose of +34 m by intravenous slow infusion over -ve minutes

http://www.uptodate.com.ezproxy.ugm.ac.id/contents/calcium-gluconate-pediatric-drug-information?source=see_linkhttp://www.uptodate.com.ezproxy.ugm.ac.id/contents/calcium-gluconate-pediatric-drug-information?source=see_link


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'odium bicarbonate

• #ncreasing the extracellular pH with sodium

bicarbonate leads to hydrogen ion movementfrom the cell into the extracellularspaceextracellular potassium moves into thecell to maintain electroneutrality

• it should not be the only therapy used in themanagement of hyperkalemia

• #n children, the dose of bicarbonate is/ mE12kg (maximum dose 4+ mE1 administeredover /+ to /4 minutes

• #t can be given as / m


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#nsulin and glucose

• Aith intravenous access, infusion of insulin andglucose can be given to mobili9e extracellular

potassium into the cells

• #nsulin administration drives extracellularpotassium into the cells by enhancing the activityof the Ba0C DT$ase pump in skeletal muscles

• lucose is given concomitantly to preventhypoglycemia

• The e"ect of insulin begins in /+ to *+ minutesand peaks at 6+ to 7+ minutes

• The major adverse e"ect is hypoglycemia, andserum glucose level should be measured onehour after the administration of insulin


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• #n children, regular insulin (dose of +3/ units perkg, maximum dose of /+ units is given alongwith a dextrose (glucose dose of +34 g2kg over 6+minutes

The administration of dextrose is based upon theage of the patient as follows:

• )hildren younger than -ve years of age: ive /+percent dextrose (/++ mg2m


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• The knowledge that 0adrenergic stimulationmodulates the translocation of potassium into the

intracellular space has prompted the considerationof agonists in the treatment of acute hyperkalemia

• a single infusion of salbutamol (4 Fg2kg over /4minutes has been shown to e"ectively lower

serum potassium concentrations within 6+ minutes• #n addition to intravenous therapy, both salbutamol

and albuterol have been found to be e"ective whengiven by inhalation

• #nhalation of albuterol during such an event in theoperating room may speed the reduction in serumpotassium

)ote, *++


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!osing of albuterol is based on the child.s weight asfollows:

•

Beonates: +3@ mg in * m< of saline3• #nfants and small children G*4 kg: *34 mg in * m<

of saline3

• )hildren between *4 and 4+ kg: 4 mg in * m< of

saline3• lder children and adolescents I4+ kg: /+ mg in

* to @ m< of saline (doses up to *+ mg have beenused3 #nhaled albuterol may also be administered

by metered dose inhaler (J!# as @ to ? pu"s witha spacer3

http://www.uptodate.com.ezproxy.ugm.ac.id/contents/albuterol-salbutamol-pediatric-drug-information?source=see_linkhttp://www.uptodate.com.ezproxy.ugm.ac.id/contents/albuterol-salbutamol-pediatric-drug-information?source=see_linkhttp://www.uptodate.com.ezproxy.ugm.ac.id/contents/albuterol-salbutamol-pediatric-drug-information?source=see_linkhttp://www.uptodate.com.ezproxy.ugm.ac.id/contents/albuterol-salbutamol-pediatric-drug-information?source=see_link


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Diuretics

•


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Hirchprung disease

• Dnesthetic concerns for patients with Hirschsprung.sdisease are similar to those for any child having surgery

• Jaintaining body temperature and providingappropriate Luid therapy (for replacement of large

thirdspace losses are the major challenges for theanesthesiologist

'mith, *+//


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• Dnesthesia induction can be either by inhalation or #Mmeans3

• Necause of the surgical bowel manipulation and therelatively obstructive nature of the underlying disease,nitrous oxide is discontinued after induction, andanesthesia is maintained with a mixture of air, oxygen,and potent inhalation agent

•


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Hiperkalemia Pada Pediatrik&Hirchprung Disease

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