Potassium Supplementation Requirement Post Orthotopic Liver Transplantation in Children

Abstract

Electrolyte disturbances, particularly hypokalemia, are a potentially underreported phenomenon among the over 500 pediatric orthotopic liver transplantations (OLTs) performed annually in the United States. Differing from the reported adult hyperkalemia during OLT, intraoperative hypokalemia has been documented in pediatric patients; however, biomedical literature reporting on the occurrence of postoperative potassium disturbances is lacking. The maintenance of potassium homeostasis is crucial to a patient’s cardiac, neuromuscular, and renal functions; alterations to potassium homeostasis may complicate their postoperative course. The goals of the study were to investigate and quantify the degree of potassium supplementation required in patients with postoperative hypokalemia and to determine whether pediatric post OLT patients possessed altered potassium needs. This retrospective study analyzed serum potassium concentrations and potassium supplementation within the pediatric OLT patients who had procedures performed between 1985-2011 at Mayo Clinic in Rochester, MN. Postoperative data from a sample size of 60 patients was examined by chart review and compared to the patient’s own baseline. Postoperative hypokalemia was noted in approximately 50% of patients within the first three postoperative days. Due to this hypokalemic state, patients required 0.5 m Eq/kg/day of potassium supplementation on average. The highest incidence of decreased serum potassium occurred within the first 72 hours post-transplantation. Age less than one year and use of diuretics were the identified variables associated with increased incidence of potassium supplementation. In conclusion, potassium supplementation is necessary in pediatric patients post OLT due to the high incidence of hypokalemia. Anticipatory and sufficient potassium supplementation in the initial postoperative period may be warranted, especially in infants. Further studies are needed to determine the etiology of this finding and its impact on morbidity and mortality in this patient population.