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Enhancement of diuresis with metolazone in infant paediatric cardiac intensive care patients

Published online by Cambridge University Press:  11 September 2017

Russell T. Wise ,
Brady S. Moffett ,
Ayse Akcan-Arikan ,
Marianne Galati ,
Natasha Afonso  and
Paul A. Checchia
Russell T. Wise
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas, United States of America
Brady S. Moffett*
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas, United States of America Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Ayse Akcan-Arikan
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Marianne Galati
Affiliation:
The Texas Medical Center Library, Houston, Texas, United States of America
Natasha Afonso
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Paul A. Checchia
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: B. S. Moffett, Pharm D, MPH, Department of Pharmacy, Texas Children’s Hospital, 6621 Fannin Street, Suite WB1120, Houston, TX 77030, United States of America. Tel: 832 824 6087; Fax: 832 825 5261; E-mail:[email protected]
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Abstract

Background

Few 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.

Methods

This 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.

Results

The 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).

Conclusions

Metolazone increased urine output in a select group of patients. Efficacy can be maximised by strategic selection of patients.

Keywords

Metolazoneloop diureticsfurosemidepaediatricsintensive care
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 27 - 31
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Copyright
© Cambridge University Press 2017 

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