A term neonate was admitted in our hospital with Circulatory failure, irregular gasping respiration and Bradicardia. ECG done at admission showed severe Hyperkalemic changes (Sign wave pattern). Baby was intubated and mechanical ventilation started. Medical treatment for Hyperkalemia (IV Calcium Gluconate, IV Soda bi – Carbonate, Insulin Glucose infusion and Salbutamol Nebulization) was ineffective and could not change the status of the baby. Blood sampling could not be done immediately since the baby was in shock.
A Double Volume Exchange Transfusion (DVET) was done to correct the Hyperkalemia and the BUN. At the end of the procedure the ECG reverted back to normal and the circulatory shock improved.
Biochemical analysis of the blood collected during DVET showed Serum Potassium 7.46 mEq/L, Sodium 143 mEq/L Urea 116.3 mg/dl and Creatinine 2.5 mg/dl. Other complications due to ARF were managed appropriately and the baby was discharged after a week of hospitalization.
On follow – up at nine months of age the baby was neurologically normal.
Conclusion:
In cases of life threatening emergency caused by Hyperkalemia due to ARF a Double Volume Exchange Transfusion may be a life saving effective procedure. Peritoneal Dialysis may not be effective in the presence of circulatory shock.
