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- Title
Enhancement of diuresis with metolazone in infant paediatric cardiac intensive care patients.
- Authors
Wise, Russell T.; Moffett, Brady S.; Akcan-Arikan, Ayse; Galati, Marianne; Afonso, Natasha; Checchia, Paul A.
- Abstract
BackgroundFew data are available regarding the use of metolazone in infants in cardiac intensive care. Researchers need to carry out further evaluation to characterise the effects of this treatment in this population.MethodsThis is a descriptive, retrospective study carried out in patients less than a year old. These infants had received metolazone over a 2-year period in the paediatric cardiac intensive care unit at our institution. The primary goal was to measure the change in urine output from 24 hours before the start of metolazone therapy to 24 hours after. Patient demographic variables, laboratory data, and fluid-balance data were analysed.ResultsThe study identified 97 infants with a mean age of 0.32±0.25 years. Their mean weight was 4.9±1.5 kg, and 58% of the participants were male. An overall 63% of them had undergone cardiovascular surgery. The baseline estimated creatinine clearance was 93±37 ml/minute/1.73 m2. Initially, the participants had received a metolazone dose of 0.27±0.10 mg/kg/day, the maximum dose being 0.43 mg/kg/day. They had also received other diuretics during metolazone initiation, such as furosemide (87.6%), spironolactone (58.8%), acetazolamide (11.3%), bumetanide (7.2%), and ethacrynic acid (1%). The median change in urine output after metolazone was 0.9 ml/kg/hour (interquartile range 0.15–1.9). The study categorised a total of 66 patients (68.0%) as responders. Multivariable analysis identified acetazolamide use (p=0.002) and increased fluid input in the 24 hours after metolazone initiation (p<0.001) as being significant for increased urine output. Changes in urine output were not associated with the dose of metolazone (p>0.05).ConclusionsMetolazone increased urine output in a select group of patients. Efficacy can be maximised by strategic selection of patients.
- Subjects
DIURESIS; METOLAZONE; PEDIATRIC intensive care; TREATMENT effectiveness; CARDIOVASCULAR surgery; FUROSEMIDE; ACETAZOLAMIDE; COMBINATION drug therapy; DIURETICS; INTENSIVE care units; MULTIVARIATE analysis; PEDIATRICS; REGRESSION analysis; RETROSPECTIVE studies; THERAPEUTICS
- Publication
Cardiology in the Young, 2018, Vol 28, Issue 1, p27
- ISSN
1047-9511
- Publication type
journal article
- DOI
10.1017/S1047951117001330