High‐dose calcium reduces early‐onset hyperkalemia in extremely preterm neonates

Background Early-onset hyperkalemiaoften occurs in extremely preterm infants during a few days after birth. While there are several treatments for hyperkalemia, calcium infusion to reduce plasma potassium concentrations remains controversial. The purpose of this study is to investigate whether a high dosage of calcium reduces early-onset hyperkalemia. Methods Extremely low-birthweight neonates born at 22–25 weeks' gestation were enrolled. We analyzed data using multivariate regression analysis and performed a retrospective cohort studywith patients divided into two groups according to the dosage of calcium in their initial infusion. Results A total of 103 patients were eligible. Early-onset hyperkalemiawas observed in 27 patients. The dosage of calcium gluconateduring 24 h after birth was the only independent factor affecting early-onset hyperkalemia. The maximum plasma potassium concentration during 72 h after birth was negatively correlated with the dosage of calcium. High-dose calcium reduced occurrences of hyperkalemiaand hypoglycemia caused by insulin infusion given for treatment of hyperkalemia, without increasing the risk of any other complications. Conclusions Infusion of calcium gluconatemay reduce early-onset hyperkalemiain a dose-dependent manner.