Hyperkalemia related cardiac arrest after massive transfusion in the newborn [Yenidoʇanda Masif Eritrosit Transfüzyonuna Baʇli Hiperpotasemi Nedeniyle Kardiyopulmoner Arrest]

Objective: the recomendations for masive transfusion for the newborn are limited with the use of fresh,saline washed red blood cells (rbc). in this article we report a newborn with cardiopulmonary arrest related to hyperkalemia after masive transfusion. case: a nineteen-days-old newborn was scheduled for intracranial mass surgery. the preoperative hemoglobin (hb) level was 16 gr dl-1. fresh,saline washed rbcs,fresh frozen plasma and platelets were prepared for transfusion. after inhalation induction the patient was hydrated with 4 ml kg-1h -1dw5-1/4ns (7 meql-1 k+ in 500 ml). radial arterial and subclavian venous canulation and invasive pressure,urine output monitorization was made. due to massive bleeding,250 ml rbc was transfused in 1 hour. since the patient experienced cardiac arrest,cardiopulmonary ressusitation (cpr) was initiated. blood gas analysis revealed ph:7,28,hco3:20,6 meql-1,po2:212 mmhg,pco2: 24mmhg sao2: %99,4,na+: 138 meql-1,k+:8,2 meql-1,cl:107 meql-1,glu:477 mg dl-1,hb:12,5 gr dl-1. calcium gluconate,furosemide,bicarbonate and glucoselinsulin infusion was initiated for the treatment of hyperkalemia along with cpr. circulation was restored 45 min after the administration of a bolus glucose/insulin. control k+ level was 6,9 meql-1. conclusion: in the newborn,despite the use of fresh,saline washed rbcs,masive transfusion can induce hyperkalemia related cardiac arrest. a bolus glucose/insulin may be effective to treat hyperkalemia related arrest. in the newborn,the k+ level of the transfused blood should be measured and replacement fluids should be prepared without k+.