Article Data

  • Views 239
  • Dowloads 13

Case Report

Open Access

Treatment of non-oliguric hyperkalaemia with inhaled salbutamol in premature infants with severe respiratory distress syndrome 


1Department of Paediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Slovenia

2 Faculty of Medicine – Division of Paediatrics, University of Ljubljana, Slovenia

DOI: 10.22514/SV141.032018.16 Vol.14,Issue 1,March 2018 pp.88-91

Published: 27 March 2018

*Corresponding Author(s): MAJA PAVCNIK E-mail:


Non-oliguric hyperkalaemia (NOHK) in neonates is defined as a plasma potassium level > 6.5 mmol/L in the presence of urine output ≥ 1 mL/kg/h during the first 72 hours of life. It is characterized by a rapid rise of serum potassium to excessively high values, a high risk of cardiac arrhythmias and no occurrence after 72 hours of birth. NOHK commonly occurs in premature neonates, especially in those with a ges-tational age <28 weeks, with only a few reports of this entity in moderate or late preterm neonates. The effectiveness and safety of different treatments for NOHK is uncertain and currently there is no firm treatment recommendation. We describe the case of a moderately premature neo-nate (32+ 2 weeks gestation), with severe neonatal respiratory distress syndrome, who developed NOHK that was treated with inhaled salbutamol. When salbuta-mol is used for the treatment of NOHK, an initial paradoxical rise in potassium levels should always be taken into account to avoid cardiac arrhythmias.


non-oliguric hyperkalaemia, premature, infants, salbutamol, hyperkalae-mia

Cite and Share

EDA VIDMAR,MAJA PAVCNIK. Treatment of non-oliguric hyperkalaemia with inhaled salbutamol in premature infants with severe respiratory distress syndrome . Signa Vitae. 2018. 14(1);88-91.


1. Xiong X, Chen D, Zhang J, Mao J, Li J. Nonoliguric hyxperkalemia in a late preterm infant with severe birth asphyxia. Transl Pediatr 2013;2:48-52.

2. Vemgal P, Ohlsson A. Intervetions for non-oliguric hyperkalemia in preterm neonates. Cochrane Database Syst Rev 2012 (cited 2017 February 19); vol5. Available from:

3. Brion LP, Schwartz GJ, Campbell D, Fleischman. Early hyperkalemia in very low birthweight infants in the absence of oliguria. Arch Dis Child 1989;64:720-2.

4. Yaseen H, Khalaf M, Dana A, Yaseen N, Darwich M. Salbutamol versus cation-exchange resin (kayexalate) for the treatment of non-oliguric hyperkalemia in preterm infants. Am J Perinatol 2008;25:193-7.

5. Mildenberger E, Versmold HT. Pathogenesis and therapy of non-oliguric hyperkalemia of the premature infant. Eur J Pediatr 2002;161:415-22.

6. Usher R. The respiratory distress syndrome of prematurity. I. Changes in potassium in the serum and the electrocardiogram and effects of therapy. Pediatr 1959;24:562-76.

7. Perkkiö M, Räihä N. Neonatal hyperkalemia. Lancet 1977;1:143.

8. Omar SA, De Cristofaro JD, Agarwal BI, LaGamma EF. Effect of prenatal steroids on potassium balance in extremely low birthweight neonates. Pediatr 2000;106:561-7.

9. Sato K, kondo T, Iwao H, Honda S, Ueda K. Internal potassium shift in premature infants: cause of nonoliguric hyperkalemia. J Pediatr 1995;126:109-13.

10. Stefano JL, Norman ME, Morales MC, Goplerud JM, Mishra OP, Delivoria –Papadopoulos M. Decreased erythrocyte Na+/K+-ATPase activity associated with cellular potassium loss in exetremely low birth infants with nonoliguric hyperkalemia. J Pediatr 1993;122:276-84.

11. Uga N, Nemoto Y, Ishii T, Kawase Y, Arai H, Tada H. Antenatal steroid treatment prevents severe hyperkalemia in very low-birth-weight infants. Pediatr Int 2003;45:656-60.

12. Lang K. K+ metabolism. In: Greger R, Windhorst U, editors. Comprehensive human physiology, vol 2. From cellular mechanisms to integration. Springer; 1996. p. 1586-1587.

13. Gruskay J, Costarino AT, Polin RA, Baumgart S. Nonoliguric hyperkalemia in the premature infant weighing less than 1000 grams. J Pediatr 1988;113:381-6.

14. Kilbride HW, Cater G, Warady BA. Early onset hyperkalemia in extremely low birth weight infants. J Perinatol 1988;8:211-4.

15. Lorenz JM, Kleinman LI, Markarian K. Potassium metabolism in extremely low birth weight infants in the first week of life. J Pediatr 1997;131:81-6.

16. Shaffer SG, Kilbride HW, Hayen LK, Meade VM, Warady BA. Hyperkalemia in very low birth weight infants. J Pediatr 1992;121:275-9.

17. Fukuda Y, Kojima T, Ono A, Matsuzaki S, Iwase S, Kobayashi Y. Factors causing hyperkalemia in premature infants. Am J Pernatol 1989;6:76-9.

18. Sychlowy A, van der Gaag H, Hannen-Hofheinz I. Hyperkalemia – a life threatening early complication of asphyxia in premature infants. Monatsschr Kinderheilkd 1990;138:62-5.

19. Bennet LN, Myers TF, Lambert GH. Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas in a 650 gram infant with hyperkalemia. Am J Perinatol 1996;13:167-70.

20. Angelopoulous M, Leitz H, Lambert G, MacGilvray S. In vitro analysis of the Na+-K+ ATPase activity in neonatal and adult red blood cells. Biol Neonate 1996;69:140.

21. Mildenberger E, Versmold H. Results of a national survey in Germanyon incidence and therapy of the nonoliguric hyperkalemia of the premature infant. Z Geburtsh Neonatol 2002;206:9-14.

22. Singh BS, Sadiq HF, Noguchi A, Keenan WJ. Efficacy of albuterol inhalation in treatmentof hyperkalemia in premature neonates. J Pediatr 2002;141:16-20.

23. Mandelberg A, Krupnik Z, Houri S, Smetana S, Gilad E, Matas Z, Priel IE. Salbutamol metered-dose inhaler with spacer for hyper-kalemia. Chest 1999;115:617-22.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time