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Aminophylline in the treatment of fluid overload
R K Pretzlaff1, R J Vardis, M M Pollack
1Division of Critical Care Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA. PretzlaffR@aol.com
Insights
Aminophylline effectively increased urine output in critically ill children with fluid overload when used with furosemide. This adjunct therapy showed no significant adverse effects on vital signs, suggesting a safe option for managing fluid balance.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Nephrology
Background:
- Fluid overload is a common complication in critically ill children.
- Diuretic resistance can occur, necessitating alternative treatment strategies.
- Aminophylline has not been extensively studied as a diuretic adjunct in this population.
Purpose of the Study:
- To evaluate the efficacy of aminophylline as an adjunct diuretic in critically ill children experiencing fluid overload.
- To assess the impact of aminophylline on urine output and electrolyte excretion.
- To determine the safety profile of aminophylline in this patient group.
Main Methods:
- An open, controlled clinical trial was conducted in a pediatric intensive care unit.
- Fluid-overloaded children (2-46 months) on high-dose furosemide received a single dose of aminophylline (6 mg/kg).
- Hemodynamic parameters and urine output were monitored before and after aminophylline administration.
Main Results:
- Aminophylline administration resulted in a significant increase in urine output (>80%) within the first 2 hours (p < .01).
- Electrolyte excretion (sodium and potassium) also increased.
- Heart rate and mean arterial pressure remained stable, showing less than a 10% change from baseline.
Conclusions:
- Aminophylline serves as an effective adjunct to furosemide for enhancing diuresis in critically ill children with fluid overload.
- This therapeutic approach can improve fluid management without compromising hemodynamic stability.
- Close monitoring of drug levels is recommended to ensure safe and effective use.
Objective:
Aminophylline has not been studied as an adjunct diuretic in critically ill children. Our purpose was to evaluate its use in the treatment of fluid overload in these patients.
Design:
Open, controlled clinical trial.
Setting:
Pediatric intensive care unit.
Patients:
Study subjects ranged from 2-46 months of age, were fluid overloaded, and were receiving a continuous infusion of furosemide (> or =6 mg/kg/day). Patients with hemodynamic instability or liver dysfunction were excluded.
Interventions:
A single dose of aminophylline (6 mg/kg) was given after establishing baseline values. There were no additional diuretics or changes in vasoactive agents during the study.
Measurements And Main Results:
Urine output, creatinine clearance, and sodium and potassium excretion were measured before and after administration of the aminophylline bolus. Heart rate and mean arterial pressure (mm Hg) were recorded hourly. Urine output increased by >80% (p < .01) during the first 2 hrs after administration of the aminophylline bolus and then returned to baseline by 4 to 6 hrs. The change in urine output is consistent with the pharmacokinetics of aminophylline. Heart rate and mean arterial pressure exhibited a change of <10% from baseline.
Conclusions:
These results suggest that aminophylline is an effective adjunct to furosemide in increasing diuresis in critically ill children with fluid overload. The increased diuresis can be accomplished without increased risk if drug levels are adequately monitored.