The response of furosemide or chlorothiazide in critically ill pediatric patients

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Critical Care and Shock


Introduction/background:Fluid overload is common in critically ill children and is associated with significant morbidity and mortality. Furo-semide is the most widely used diuretic to man-age excess fluid. In addition to loop diuretics, thiazide diuretics may be used to enhance urine out-put. Data and information regarding safe and ef-fective dosing of furosemide and chlorothiazide in the critically ill pediatric population are lack-ing. The primary objective of this study was to compare urine output 24 hours after initiation of furosemide or chlorothiazide in critically ill chil-dren. Methods: This was a multi-center retrospective cohort study conducted at 3 academic medical centers. Children between the ages of 1 day and 17 years that received at least one dose of intravenous or oral diuretics from February 2013 to January 2017 were included. Patients with bron-chopulmonary dysplasia or on home diuretics were excluded. Only the first dose of diuretic was included in the study. Patients were divided into two groups: furosemide versus chlorothiazide. Urine output 24 hours prior to the diuretic was compared to urine output 24 hours after initiation of the diuretic. Results: There were 133 patients identified who met the inclusion criteria for the study. There were 88 patients that received at least one dose of furosemide and 45 that received at least one dose of chlorothiazide. Most patients were male (49, 55.7%) with a median age of 2.3 years. The median dose for furosemide was 0.7 mg/kg and for chlorothiazide was 2.4 mg/kg. There were no statistically significant differences between baseline urine output for furosemide (2.9 ml/kg/hr) or chlorothiazide (2.8 ml/kg/hr), p=0.6. Although not statistically different, urine output 24 hours after the diuretic dose increased by 0.84 ml/kg/hr for furosemide and 0.73 ml/kg/hr for chlorothia-zide, p=0.45. Conclusion: Furosemide and chlorothiazide resulted in similar urine output changes 24 hours after an intravenous dose.

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