Intra-operative hyperkalaemia in a toddler

Hyperkalaemia is primarily a problem when whole blood is administered rapidly. However, it can happen with small amounts of old stored blood transfusions in infants and small children due to high K+ content of the old blood. We present a 2-year-old baby who developed intraoperative hyperkalaemia during a reduction cranioplasty for enlarged head, secondary to hydrocephalus resulting from posterior third ventricular choroid plexus papilloma. Intraoperatively the child had massive blood loss. While blood transfusion was being carried out rapidly [three weeks old blood]. the patient became haemodynamically unstable and showed ECG changes. Blood tests revealed a K+ of 6.9mmol/l and acidosis, which was treated with calcium, glucose and insulin