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Spironolactone effect on potassium supplementation in paediatric cardiac intensive care patients
B S Moffett1, T E Haworth1, Y Wang2
1Department of Pharmacy, Texas Children's Hospital, Houston, TX, USA.
Insights
Spironolactone did not significantly alter potassium supplementation needs in pediatric cardiac intensive care patients. This suggests routine spironolactone use may not be more effective than potassium supplementation alone for maintaining serum potassium levels.
Area of Science:
- Pediatric Cardiology
- Intensive Care Medicine
- Pharmacology
Background:
- Spironolactone is utilized in pediatric patients with heart conditions.
- Limited data exist on spironolactone's impact on potassium supplementation in this population.
- This study addresses the gap in understanding spironolactone's effect on potassium management.
Purpose of the Study:
- To determine the effect of spironolactone on the requirement for potassium supplementation.
- To compare potassium supplementation needs in pediatric cardiac intensive care patients receiving furosemide with or without spironolactone.
- To evaluate serum potassium concentrations and the incidence of hypokalemia and hyperkalemia.
Main Methods:
- Retrospective, propensity-matched cohort study.
- Inclusion criteria: pediatric patients in the cardiac intensive care unit receiving furosemide.
- Matched patients receiving spironolactone to those who did not; collected data on demographics, diuretics, and potassium monitoring.
Main Results:
- A total of 448 patients were analyzed; 90.4% underwent cardiovascular surgery.
- Median potassium supplementation did not differ significantly between groups (4.6 mEq/kg vs 6.5 mEq/kg, P=.13).
- No significant differences were observed in the rates of hypokalemia (27.8% vs 31.2%, P=.06) or hyperkalemia (2.8% vs 3.2%, P=.49).
Conclusions:
- Spironolactone administration did not reduce the need for potassium supplementation in this cohort.
- Routine spironolactone use in pediatric cardiac intensive care patients may not offer advantages over potassium supplementation for maintaining serum potassium.
- Further research may clarify the role of spironolactone in managing electrolyte balance in critically ill children with heart disease.
What Is Known:
Spironolactone is used in paediatric patients with heart disease, yet few data are available regarding the impact on potassium supplementation.
Objective:
We sought to determine the effect of spironolactone on potassium supplementation in paediatric cardiac intensive care patients.
Methods:
A retrospective, propensity matched cohort study was designed. Patients were included in the study if they received furosemide therapy in the cardiac intensive care unit at our institution. Patients who received spironolactone were matched to patients who did not receive spironolactone. Data collection included patient demographics, diuretic data, potassium monitoring, and total milliequivalents of potassium administered during the cardiac intensive care unit stay.
Results And Discussion:
A total of 448 patients met study criteria median age 0.43 (IQR 0.06-3.52) years, 58.9% male. Intensive care unit length of stay was 7 (IQR 3-17) days, cardiovascular surgery occurred in 90.4%. Patients had a mean 4.6±2.6 potassium concentrations assessed per day (29.5%±19.4%<3.5 mmol/L, and 2.9%±6.5%>5.5 mmol/L). Patients received a median of 5.1 mEq/kg (0-323.4 mEq/kg) of potassium. Spironolactone (n=224) was administered for 2 days (IQR 1-4) at mean dose of 0.64±0.54 mg kg-1 d-1 . Median total mEq/kg of potassium administered did not differ between groups (4.6 mEq/kg (IQR 0.66-16.8) vs 6.5 mEq/kg (IQR 1.3-18.3 mEq/kg), P=.13). Potassium laboratory values did not differ in hypokalemia (27.8%±19.1% vs 31.2%±19.5%, P=.06) or hyperkalemia (2.8%±5.4% vs 3.2%±7.5%, P=.49) between groups.
What Is New:
Spironolactone supplementation did not reduce the need for potassium supplementation in paediatric cardiac intensive care patients.
Conclusion:
The routine use of spironolactone in the paediatric cardiac intensive care population may not be more efficacious than potassium supplementation for maintenance of serum potassium concentrations.
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