Infantile hemangioma are the most common benign vascular tumors of infancy and childhood. They usually appear at birth or soon after and their natural history follows a biphasic evolution: a proliferative phase until the maximal size is reached, within the first 4 to 6 months and an involutive phase that can last for years. A treatment is usually not needed unless the growth has an impact on a functional organ or evolves with ulceration. Peroral propranolol is the first line medical treatment.
We report a 4-month old girl, born at 34,0 weeks of gestational age with an infantile hemangioma of the upper lip. Considering the growing size and the potential of interfering with breathing, feeding and the risk of residual disfigurement a treatment with propranolol 1mg per kg BID was started at the age of 4 days. A propranolol-induced hyperkalemia of 6.2 mmol/l (normal: 3.5-5mmol/l) was found after one week of treatment. The kalemia remained at a pathologic level even though the propranolol regimen was reduced to 0,5 mg/kg. The development of an ulceration of her hemangioma with ongoing hyperkalemia lead us to switch the treatment to oral atenolol. Under this treatment, the hyperkalemia resolved and her hemangioma started to regress.
Even though propranolol has a long standing record safety, a close monitoring with its use is recommended. Atenolol can be an alternative for the treatment. Selective betablockers have little effect on kaliemia as they do not block beta2 receptors, which induce the shift of potassium from extra- to intracellular.

Hyperkaliemia a not well-known potential side effect of propranolol treatment in infantile hemangiomas.

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