Hyperkalemia is less common than hypokalemia in pediatric patients, though it is not uncommon to have hemolysis in patients who receive heel stick lab work.
The age of the patient is critical to determining the cutoff for hyperkalemia:
Premature infant 4.0–6.5 mmol/L
Newborn 3.9–5.9 mmol/L
Infant 4.1–5.3 mmol/L
Child 3.4–4.7 mmol/L
Typically, levels up 6.0mmol/L are well tolerated in children, unless the shift is rapid. For any child meeting age related hyperkalemia or who have a known lower prior potassium level should receive an ECG.
Treatment for hyperkalemia is similar to adults
Calcium Chloride (20mmg/kg - Max 1g) or Calcium Gluconate (0.5ml/kg - Max 20ml) is given for cardiac stability.
Albuterol can be given based on weight
Insulin and dextrose can be used with extreme caution and close monitoring for hypoglycemia. (Dextrose should be given as D10% in children under 5 years of age, D25% can be used if > 5 years old)
References
Brown DH, Paloian NJ. Hypokalemia/Hyperkalemia and Hyponatremia/Hypernatremia. Pediatr Rev. 2023 Jul 1;44(7):349-362. doi: 10.1542/pir.2021-005119. PMID: 37391630.
