Pädiatrie und Therapeutik
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Electrolyte Imbalance Caused by Diuretic Therapy in Infants with Congenital Heart Diseases

Kiyoshi Ogawa, Fumie Kawachi, Takuma Mori and Kenji Hoshino

Background: Although furosemide and spironolactone are widely used to treat heart failure in infants and children because of their effectiveness and few side effects, there have been no prospective studies about the frequency and degree of serum electrolyte abnormality after the use of diuretics in pediatric patients.

Methods: We prospectively studied 126 infants at our outpatient clinic aged less than 2 months old with left-toright shunt who received oral diuretics. All patients were started on furosemide at 0.5~3 mg/kg/day and spironolactone at 0.5~2 mg/kg/day, orally divided into two or three doses according to the degree of congestive heart failure.

Results: Serum sodium level ranged from 128 to 142 mEq/L (mean 136 mEq/L) and was <134 mEq/L in 18 of 126 patients (14.3%). Serum potassium level ranged from 4.5 to 6.9 mEq/L (mean 5.5 mEq/L) and was more than 5.5 mEq/L in 68 patients. Hyperkalemia (serum potassium level >6.0 mEq/L) was complicated in 19 patients. Eighteen patients with sodium levels of <134 mEq/L after diuretics showed lower body weight at the start of diuretics and lower postnatal age than the patients with serum sodium levels ≥ 134 mEq/L.

Conclusion: Although neither severe hyponatremia nor hypokalemia developed, there were a few patients with prolonged hyponatremia after diuretic therapy. It seems to be preferable to monitor serum electrolyte levels carefully after the start of diuretic therapy in infants with congenital heart disease.