Bumetanide continuous infusions in critically ill pediatric patients
Katie M McCallister1, Rebecca F Chhim, Mario Briceno-Medina
11Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN. 2Le Bonheur Children's Hospital, Memphis, TN. 3Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN.
Insights
Continuous bumetanide infusions effectively achieved negative fluid balance in most critically ill children. This study indicates bumetanide is a safe and effective loop diuretic for pediatric intensive care unit patients.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Nephrology
Background:
- Limited data exist regarding the efficacy and safety of continuous bumetanide infusions in pediatric patients.
- Fluid overload is a common complication in critically ill children, necessitating effective diuretic strategies.
- Understanding optimal dosing and outcomes for bumetanide continuous infusions is crucial for managing fluid balance in this population.
Purpose of the Study:
- To evaluate the use of bumetanide continuous infusions in critically ill pediatric patients.
- To assess the effectiveness of bumetanide in achieving negative fluid balance.
- To determine the safety profile of bumetanide continuous infusions in this patient group.
Main Methods:
- Retrospective chart review of 95 critically ill pediatric patients (≤18 years) receiving bumetanide continuous infusions.
- Dosing evaluated by rate (μg/kg/hr) and duration (days).
- Efficacy assessed by negative fluid balance at 12, 24, and 48 hours; safety evaluated by adverse drug reactions.
Main Results:
- Mean bumetanide dose was 5.7 ± 2.2 μg/kg/hr, with a median duration of 3.3 days.
- 76% of patients achieved negative fluid balance by 48 hours.
- 54% of patients reached negative fluid balance within the first 12 hours.
Conclusions:
- A bumetanide dose of 5.7 μg/kg/hr was effective in achieving negative fluid balance in the majority of critically ill pediatric patients.
- Bumetanide appears to be a safe loop diuretic for continuous infusion in critically ill pediatric patients at the studied doses.
- Continuous bumetanide infusion is a viable option for fluid management in pediatric intensive care settings.
Objective:
Limited data exist for the use of bumetanide continuous infusions in children. The purpose of this study was to evaluate the use of bumetanide continuous infusions in critically ill pediatric patients.
Design:
This study was an institutional review board approved, single-center, retrospective chart review of 95 patients. Dosing practices were described by rate (μg/kg/hr), duration (days), and previous diuretic use. Efficacy, determined by ability to achieve negative fluid balance and time to reach negative fluid balance, was assessed at 12, 24, and 48 hours. Safety was evaluated based on prevalence of adverse drug reactions. Adverse drug reactions were predefined as serum potassium concentration less than 3 mEq/L, serum chloride concentration less than 90 mEq/L, serum carbon dioxide concentration greater than 35 mEq/L, and serum creatinine increased greater than 1.5 times baseline and above patient-specific normal range.
Setting:
Le Bonheur Children's Hospital, Memphis, TN.
Patients:
Critically ill patients who are 18 years old or younger and received bumetanide continuous infusions. A total of 95 patients were included.
Interventions:
None.
Measurements And Main Results:
The mean dose of bumetanide was 5.7 ± 2.2 μg/kg/hr (1-10 μg/kg/hr) with a median duration of 3.3 days (0.3-18.5). The total percentage of patients achieving negative fluid balance by 48 hours was 76% with 54% of patients reaching negative fluid balance within 12 hours.
Conclusions:
This study showed that a bumetanide dose of 5.7 μg/kg/hr was effective in achieving negative fluid balance in the majority of critically ill pediatric patients. Additionally, bumetanide appears to be a safe loop diuretic for use as a continuous infusion at the doses described in critically ill pediatric patients.
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