Serum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic response

Abstract Background Electrolyte disturbances are not uncommon in patients on chronic furosemide therapy. We hypothesized that serum chloride (Cl) and serum sodium (Na) abnormalities may occur in children on prolonged furosemide therapy affecting the diuretic response in these children. Methods The s...

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Main Authors: Nanies Mohamed Salah EL Din Soliman, Alyaa Amal Kotby, Menatallah Ali Shabaan, Esraa Matarawy Eid
Format: Article
Language:English
Published: SpringerOpen 2022-10-01
Series:Egyptian Pediatric Association Gazette
Subjects:
Online Access:https://doi.org/10.1186/s43054-022-00116-z
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author Nanies Mohamed Salah EL Din Soliman
Alyaa Amal Kotby
Menatallah Ali Shabaan
Esraa Matarawy Eid
author_facet Nanies Mohamed Salah EL Din Soliman
Alyaa Amal Kotby
Menatallah Ali Shabaan
Esraa Matarawy Eid
author_sort Nanies Mohamed Salah EL Din Soliman
collection DOAJ
description Abstract Background Electrolyte disturbances are not uncommon in patients on chronic furosemide therapy. We hypothesized that serum chloride (Cl) and serum sodium (Na) abnormalities may occur in children on prolonged furosemide therapy affecting the diuretic response in these children. Methods The study included 45 children, with congenital left to right shunts causing chronic congestive state which necessitated chronic furosemide therapy. Patients in need to an increase of their furosemide dose were recruited in the study. We assessed serum Cl and serum Na as well as parameters of diuretic responsiveness; net fluid output and change in body weight/40 mg furosemide, and change in urinary Na/K ratio. These parameters were assessed initially and at day 3 after increasing furosemide dose. Results According to serum levels of Cl and Na, patients were divided into four groups: isolated hyponatremia (15 patients, 33.3%), isolated hypochloremia (9 patients, 20%), combined hypochloremia and hyponatremia (12 patients, 26.7%), and normal serum electrolytes (9 patients, 20%). Patients with combined hyponatremia and hypochloremia and those with isolated hypochloremia showed minimal clinical and radiological signs of decongestion as well as lowest changes in urinary Na/K ratio, fluid output and weight change/40 mg furosemide on augmenting the diuretic dose, unlike the hyponatremic patients who had near normal parameters with no evidence of diuretic resistance. Conclusion Both hypochloremia and hyponatremia are common in patients on prolonged furosemide therapy. Hypochloremia is associated with a poor diuretic response, unlike isolated hyponatremia which does not seem to affect the diuretic response. Concomitant occurrence of hyponatremia and hypochloremia is associated with poor diuretic response as well which can be worse than that seen in isolated hypochloremia.
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spelling doaj.art-e6f1c943cc1c49aaa5b25591412378f92022-12-22T02:24:37ZengSpringerOpenEgyptian Pediatric Association Gazette2090-99422022-10-017011810.1186/s43054-022-00116-zSerum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic responseNanies Mohamed Salah EL Din Soliman0Alyaa Amal Kotby1Menatallah Ali Shabaan2Esraa Matarawy Eid3Pediatrics Department, Children’s Hospital, Faculty of Medicine, Ain Shams UniversityPediatrics Department, Children’s Hospital, Faculty of Medicine, Ain Shams UniversityClinical Pathology Department, Faculty of Medicine, Ain Shams UniversityPediatrics Department, Children’s Hospital, Faculty of Medicine, Ain Shams UniversityAbstract Background Electrolyte disturbances are not uncommon in patients on chronic furosemide therapy. We hypothesized that serum chloride (Cl) and serum sodium (Na) abnormalities may occur in children on prolonged furosemide therapy affecting the diuretic response in these children. Methods The study included 45 children, with congenital left to right shunts causing chronic congestive state which necessitated chronic furosemide therapy. Patients in need to an increase of their furosemide dose were recruited in the study. We assessed serum Cl and serum Na as well as parameters of diuretic responsiveness; net fluid output and change in body weight/40 mg furosemide, and change in urinary Na/K ratio. These parameters were assessed initially and at day 3 after increasing furosemide dose. Results According to serum levels of Cl and Na, patients were divided into four groups: isolated hyponatremia (15 patients, 33.3%), isolated hypochloremia (9 patients, 20%), combined hypochloremia and hyponatremia (12 patients, 26.7%), and normal serum electrolytes (9 patients, 20%). Patients with combined hyponatremia and hypochloremia and those with isolated hypochloremia showed minimal clinical and radiological signs of decongestion as well as lowest changes in urinary Na/K ratio, fluid output and weight change/40 mg furosemide on augmenting the diuretic dose, unlike the hyponatremic patients who had near normal parameters with no evidence of diuretic resistance. Conclusion Both hypochloremia and hyponatremia are common in patients on prolonged furosemide therapy. Hypochloremia is associated with a poor diuretic response, unlike isolated hyponatremia which does not seem to affect the diuretic response. Concomitant occurrence of hyponatremia and hypochloremia is associated with poor diuretic response as well which can be worse than that seen in isolated hypochloremia.https://doi.org/10.1186/s43054-022-00116-zPediatricHeart failureFurosemideDiuretic resistanceHyponatremiaHypochloremia
spellingShingle Nanies Mohamed Salah EL Din Soliman
Alyaa Amal Kotby
Menatallah Ali Shabaan
Esraa Matarawy Eid
Serum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic response
Egyptian Pediatric Association Gazette
Pediatric
Heart failure
Furosemide
Diuretic resistance
Hyponatremia
Hypochloremia
title Serum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic response
title_full Serum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic response
title_fullStr Serum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic response
title_full_unstemmed Serum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic response
title_short Serum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic response
title_sort serum chloride and serum sodium derangements in children on prolonged furosemide therapy and their effect on diuretic response
topic Pediatric
Heart failure
Furosemide
Diuretic resistance
Hyponatremia
Hypochloremia
url https://doi.org/10.1186/s43054-022-00116-z
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