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Intravenous vasopressin and gastrointestinal hemorrhage in children
D W Tuggle1, K G Bennett, J Scott
1Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City.
Insights
Intravenous vasopressin effectively controlled gastrointestinal bleeding in children in 53% of cases. Higher doses increased complications without improving bleeding control, suggesting a need for cautious use in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Critical Care Medicine
- Pharmacology
Background:
- Intravenous vasopressin is a long-standing treatment for upper gastrointestinal hemorrhage in adults.
- Pediatric data on vasopressin for gastrointestinal bleeding are limited.
- This study investigates vasopressin's efficacy and safety in children.
Purpose of the Study:
- To evaluate the effectiveness of intravenous vasopressin in controlling pediatric upper gastrointestinal hemorrhage.
- To assess the incidence of complications associated with vasopressin therapy in children.
- To determine if higher doses of vasopressin improve bleeding control or increase adverse events.
Main Methods:
- Retrospective analysis of 17 episodes of upper gastrointestinal hemorrhage in children treated with intravenous vasopressin.
- Evaluation of bleeding control rates, need for adjunctive therapies (balloon tamponade, sclerosis), and blood transfusion requirements.
- Analysis of metabolic complications in relation to vasopressin dosage, specifically comparing doses above and below 0.01 units/kg/min.
Main Results:
- Vasopressin alone controlled bleeding in 9 out of 17 episodes (53%).
- Adjunctive therapies were required in the remaining episodes.
- Metabolic complications occurred in 65% of episodes, exclusively in patients receiving >0.01 units/kg/min.
- Higher vasopressin doses did not improve bleeding control but were associated with increased complications (P < .05).
Conclusions:
- Intravenous vasopressin can control pediatric upper gastrointestinal bleeding, but often requires adjunctive measures.
- Doses exceeding 0.01 units/kg/min are linked to a higher incidence of metabolic complications without enhancing hemostatic efficacy.
- Lower doses of intravenous vasopressin should be considered in pediatric patients to minimize adverse events.
Abstract:
Intravenous (IV) vasopressin has been used to control human upper gastrointestinal (GI) hemorrhage for over 30 years. Although the use of vasopressin has been studied extensively in adults, no study has evaluated its use in children. Vasopressin was used therapeutically in 15 episodes of esophageal variceal hemorrhage and two episodes of bleeding peptic ulcer. Nine of 17 episodes were controlled with vasopressin alone (53%). Balloon tamponade and variceal sclerosis were required for control in the remainder. Blood requirements averaged 53 mL/kg prior to control of hemorrhage. Metabolic complications occurred in 65% of the episodes. There were two groups of patients identified: those receiving greater or those receiving less than .01 units/kg/min of IV vasopressin. All of the complications identified occurred when greater than .01 U/kg/min of vasopressin were used (P less than .05). Control of bleeding was not improved with higher doses of vasopressin. These data suggest that the use of IV vasopressin at doses greater than .01 U/kg/min to control GI bleeding will increase the incidence of complications without improving control of hemorrhage.