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was told by my attending that hyperkalemia is normal in a neonate. the kid also had a bicarb of 11. how can this K possibly be normal?
K of 6.5
- Thread starter Eidee
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From the Harriet Lane Handbook (always look up age-based normals for labs and V.S. for kids):
Bicarb:
Newborn: 17-24 mEq/L (mmol/L)
2mo-2yo: 16-24
>2yo: 22-26
K+:
Newborn: 3.7-5.9
Infant: 4.1-5.3
Child: 3.4-4.7
Adult: 3.5-5.1
And like most things in medicine, what is the clinical context? Does he have a reason to be mildly hyperkalemic and definitely acidotic? Is he dehydrated and going into rhabdo (or just dehydrated)? And more importantly is he symptomatic: It's mild hyperkalemia but significantly acidotic-if he's dehydrated he needs to be appropriately fluid resuss'ed. If he has EKG findings c/w symptomatic hyper K then treat it like it's symptomatic hyper K (CaGluconate, dextrose/insulin, albuterol...though at 6.5 he may not have EKG changes, but his myocardium may be irratable from its acidotic environment [if truly acidotic]). And secondary to addressing any acute issues of stabilization: what lab, how drawn, and what happened to it after it left the patient's bedside. Is this a BMP or electrolytes and bicarb from a gas (estimated bicarb so not to be believed unless confirmed by BMP). Was this a heel stick sample, an art, or venous sample and did they have to squeeze the crap out of the sample site to get the blood. Did the sample sit on a shelf in the lab for two hours before being run? Hemolyzed samples will have a high K+ and lowered bicarb (and sometimes elevated BUN) as the red cells lyse. Any hemolysis noted on your lab printout (or call the running lab tech and ask)? If this kid had no history or PE findings that would explain the labs I would run down the hemolysis avenue first. If there was no evidence of hemolysis and the child was completely asymptomatic with a benign history (then why were the labs sent in the first place?) I would just resend the labs and still make sure that the person who draws it minimizes any chance of hemolysis-hey, get a procedure and draw a good art stick and get a quick peak on ABG electrolytes while your waiting for your BMP to come back🙂). And then, if still abnormal, go down to your differential of acidosis (gap vs. non-gap... does this kid have RTA4?)
Mind sharing the rest of the story-good learning case.
Bicarb:
Newborn: 17-24 mEq/L (mmol/L)
2mo-2yo: 16-24
>2yo: 22-26
K+:
Newborn: 3.7-5.9
Infant: 4.1-5.3
Child: 3.4-4.7
Adult: 3.5-5.1
And like most things in medicine, what is the clinical context? Does he have a reason to be mildly hyperkalemic and definitely acidotic? Is he dehydrated and going into rhabdo (or just dehydrated)? And more importantly is he symptomatic: It's mild hyperkalemia but significantly acidotic-if he's dehydrated he needs to be appropriately fluid resuss'ed. If he has EKG findings c/w symptomatic hyper K then treat it like it's symptomatic hyper K (CaGluconate, dextrose/insulin, albuterol...though at 6.5 he may not have EKG changes, but his myocardium may be irratable from its acidotic environment [if truly acidotic]). And secondary to addressing any acute issues of stabilization: what lab, how drawn, and what happened to it after it left the patient's bedside. Is this a BMP or electrolytes and bicarb from a gas (estimated bicarb so not to be believed unless confirmed by BMP). Was this a heel stick sample, an art, or venous sample and did they have to squeeze the crap out of the sample site to get the blood. Did the sample sit on a shelf in the lab for two hours before being run? Hemolyzed samples will have a high K+ and lowered bicarb (and sometimes elevated BUN) as the red cells lyse. Any hemolysis noted on your lab printout (or call the running lab tech and ask)? If this kid had no history or PE findings that would explain the labs I would run down the hemolysis avenue first. If there was no evidence of hemolysis and the child was completely asymptomatic with a benign history (then why were the labs sent in the first place?) I would just resend the labs and still make sure that the person who draws it minimizes any chance of hemolysis-hey, get a procedure and draw a good art stick and get a quick peak on ABG electrolytes while your waiting for your BMP to come back🙂). And then, if still abnormal, go down to your differential of acidosis (gap vs. non-gap... does this kid have RTA4?)
Mind sharing the rest of the story-good learning case.
