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Off-label use of propranolol for treatment of infantile hemangiomas has become more frequent since publication of successful case reports. However, adverse effects, including hypotension, hypoglycemia, and bronchospasm, have also been described in other reports. Now, these authors describe a novel, potentially serious reaction — significant hyperkalemia.
In a female infant (birthweight, 735 g) delivered by cesarean section at 28 weeks' gestation because of placental insufficiency, a small hemangioma was noted on the lateral chest at age 5 days and became an ulcerated tumor (size, 11×8×1.5 cm) by 17 weeks. Magnetic resonance imaging revealed extension of the hemangioma into intercostal musculature, with faint enhancement on pleura and liver. …