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Furosemide effect on mineral status of parenterally nourished premature neonates with chronic lung disease
1Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Prolonged furosemide use in premature infants with lung disease disrupts calcium and phosphorus balance, increasing urinary losses and parathyroid hormone levels. This suggests furosemide may cause secondary hyperparathyroidism, impacting mineral homeostasis.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Pediatric Pulmonology
Background:
- Very low birth weight infants with chronic lung disease often require prolonged medical support.
- Furosemide is commonly used in this population but can affect mineral metabolism.
- Calcium and phosphorus homeostasis is critical for bone health and overall development in neonates.
Purpose of the Study:
- To investigate the impact of prolonged furosemide administration on calcium and phosphorus homeostasis in very low birth weight infants with chronic lung disease.
- To determine if different phosphorus intake levels influence these effects.
- To assess the relationship between furosemide, urinary mineral excretion, and parathyroid hormone levels.
Main Methods:
- A study involving 16 parenterally nourished very low birth weight infants with chronic lung disease.
- Administration of three different daily phosphorus dosages: low, moderate, and high.
- Measurement of urinary calcium, phosphate, and cyclic adenosine monophosphate excretion.
- Assay of parathyroid hormone concentrations.
Main Results:
- Furosemide-treated infants exhibited elevated urinary calcium, phosphate, and cyclic adenosine monophosphate excretion, irrespective of phosphorus intake.
- Parathyroid hormone levels were significantly higher in furosemide-treated infants compared to those not receiving furosemide.
- These effects were observed across different phosphorus supplementation levels.
Conclusions:
- Prolonged furosemide administration significantly alters calcium and phosphorus homeostasis in very low birth weight infants with chronic lung disease.
- Elevated urinary mineral losses and increased parathyroid hormone concentrations suggest a potential for secondary hyperparathyroidism.
- Careful monitoring of mineral balance and parathyroid hormone is warranted in these infants receiving furosemide.
Abstract:
In this study, the effect of prolonged furosemide administration on calcium and phosphorus homeostasis was examined in 16 parenterally nourished very low birth weight infants with chronic lung disease. Patients received one of three different dosages of phosphorus: low, 0.91 +/- 0.06 mmol/kg per day; moderate, 1.24 +/- 0.02 mmol/kg per day; and high, 1.64 +/- 0.06 mmol/kg per day. All furosemide-treated patients had high levels of urinary calcium (12.1 +/- 2.2 mg/kg per day), phosphate (19.1 +/- 2.7 mg/kg per day), and cyclic 3'5'-adenosine monophosphate (76.8 +/- 6.7 nmol/kg per day) excretion, independent of their phosphorus intake. Parathyroid hormone concentrations were high in furosemide-treated patients (0.95 +/- 0.15 ng/mL) compared with patients not treated with furosemide and receiving either moderate (0.49 +/- 0.05 ng/mL) or low (0.42 +/- 0.07 ng/mL) phosphorus intakes. Furosemide administration may lead to secondary hyperparathyroidism.