Preventive strategy for hyperkalemia during resection of a large sacrococcygeal teratoma in a neonate

A neonate weighed 3.3kg with a huge Sacrococcygeal teratoma extending up to the level of S3, anterior displacement of the anus and rectum underwent operation. He had hyperkalemia caused by massive transfusion and tumor lysis. Regular insulin 0.3 unit and 4ml of normal saline mixture were infused by microinfusion pump at a rate of 3cc/hr with continuous 10% dextrose solution during resection of tumor. During the operation, appropriate potassium concentration was maintained and surgery was completed uneventfully.