Ethacrynic Acid continuous infusions in critically ill pediatric patients
Jamie L Miller1, Jared Schaefer1, Matthew Tam1
1Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma.
Insights
This study explored ethacrynic acid continuous infusions in critically ill children, finding median initial doses of 0.13 mg/kg/hr and maximum doses of 0.17 mg/kg/hr. Further research is needed to confirm these findings.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Nephrology
Background:
- Continuous infusions (CI) of ethacrynic acid are used in critically ill children.
- Limited data exists on optimal dosing and outcomes for this patient population.
Purpose of the Study:
- To describe dosage regimens for ethacrynic acid CI in critically ill children.
- To evaluate treatment outcomes, including urine output, fluid balance, and adverse events.
Main Methods:
- Retrospective cross-sectional study of pediatric patients (<18 years) receiving ethacrynic acid CI >12 hours (2007-2012).
- Analysis of initial and maximum doses, urine output, fluid balance, and electrolyte abnormalities.
- Repeated measures ANOVA used to assess changes in efficacy markers and adverse events.
Main Results:
- Nine patients were included. Median initial dose was 0.13 mg/kg/hr; median maximum dose was 0.17 mg/kg/hr.
- Significant improvements in urine output and fluid balance were observed mid- and post-therapy compared to pre-therapy.
- 55.6% of patients developed metabolic alkalosis; no significant changes in magnesium or potassium levels were noted.
Conclusions:
- Ethacrynic acid CI shows preliminary efficacy in critically ill children.
- The median effective doses were established, but larger prospective studies are required for confirmation.
Objectives:
The purpose of this study was to describe dosage regimens and treatment outcomes in critically ill children receiving ethacrynic acid continuous infusions (CI).
Methods:
This retrospective cross-sectional study evaluated patients less than 18 years of age who received ethacrynic acid CI with a duration exceeding 12 hours, from January 1, 2007, through January 31, 2012. The primary objective was to determine the mean/median doses of ethacrynic acid CI. Secondary objectives were to assess surrogate efficacy markers (e.g., urine output [UOP], fluid balance) and the number of patients with electrolyte abnormalities or metabolic alkalosis. Descriptive statistics were used. A series of repeated measures analyses of variance were conducted to assess differences in surrogate efficacy markers and in adverse events that occurred pre-, mid-, and posttherapy.
Results:
Nine patients were included. The mean ± SD initial and maximum doses (mg/kg/hr) were 0.13 ± 0.07 (median 0.1; range, 0.08-0.3) and 0.17 ± 0.08 (median, 0.16; range 0.09-0.3), respectively. The median UOP (mL/kg/hr) pre-, mid-, and postinfusions (interquartile range [IQR]) were 2.4 (1.8-3.2), 4.2 (3.5-6), and 4 (3.4-5.3), respectively. The median fluid balance (mL; IQR) was 189 (90-526), -258 (-411.7 to 249) and -113.5 (-212.5 to 80.2), respectively. There were statistically significant differences in UOP and fluid balance pre- versus mid-therapy (0.014) and pre- versus posttherapy (p=0.010). No significant differences were noted with magnesium and potassium. Five children (55.6%) developed metabolic alkalosis.
Conclusions:
This study provides preliminary evidence for ethacrynic acid CI in children. The median initial dose and maximum dose in this cohort were 0.13 mg/kg/hr and 0.17 mg/kg/hr, respectively. Larger prospective studies are needed to confirm these findings.
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