Journal article
Addition of metolazone to overcome tolerance to furosemide in infants with bronchopulmonary dysplasia
The Journal of pediatrics, Vol.120(6), pp.966-973
1992
DOI: 10.1016/S0022-3476(05)81972-9
PMID: 1593359
Abstract
A decreased response to the loop diuretic furosemide develops within a few doses in young infants. We tested the hypothesis that the use of the thiazide-like diuretic metolazone, in combination with furosemide, would inhibit water and electrolyte reabsorption and overcome pharmacologic tolerance to furosemide alone. Infants with bronchopulmonary dysplasia of similar gestational and postnatal ages were randomly assigned to one of three groups. Group 1 (n=6) received furosemide (1 mg/kg per dose) intravenously every 24 hours for a total of five doses. Group 2 (n=8) received the same treatment as group 1, but in addition metolazone (0.2 mg/kg per dose) was given enterally with doses 3 and 4 of furosemide. Group 3 (n=8) received metolazone (0.2 mg/kg per dose) enterally every 24 hours for five doses. Urine was collected before the first diuretic dose and throughout the study for determination of the urine flow rate; urinary excretion of sodium, chloride, and potassium; and creatinine clearance. Urinary flow rate and urinary sodium and chloride excretion increased after the first dose in all groups. In the infants treated with either furosemide or metolazone, urinary flow rate and urinary and chloride excretion returned to baseline values after the last three doses. In contrast, when furosemide was administered with metolazone, urinary flow rate and urinary excretion of sodium, chloride, and potassium were greater than the values for baseline and for the previous dose, as well as for the corresponding doses of furosemide in group 1 and metolazone in group 3. Tolerance to furosemide (group 1) and metolazone (group 3) appeared to be explained by compensatory increased sodium and chloride reabsorption without changes in creatinine clearance. We conclude that the administration of metolazone with furosemide enhances diuresis, natriuresis, and chloruresis and overcomes the rapid development of tolerance to furosemide in infants with bronchopulmonary dysplasia by blocking the compensatory increase in renal sodium and chloride absorption.
Details
- Title: Subtitle
- Addition of metolazone to overcome tolerance to furosemide in infants with bronchopulmonary dysplasia
- Creators
- Jeffrey L. Segar - University of IowaJean E. Robillard - University of IowaKaren J. Johnson - University of IowaEdward F. Bell - University of IowaSylvain Chemtob - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.120(6), pp.966-973
- Publisher
- Mosby, Inc
- DOI
- 10.1016/S0022-3476(05)81972-9
- PMID
- 1593359
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Language
- English
- Date published
- 1992
- Academic Unit
- Molecular Physiology and Biophysics; Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Neonatology; Medicine Administration
- Record Identifier
- 9984353938202771
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