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Hypochloremia Secondary to Diuretics in Preterm Infants: Should Clinicians Pay Close Attention?
Renjithkumar Kalikkot Thekkeveedu1, Sumana Ramarao1, Nilesh Dankhara1
1University of Mississippi Medical Center, Jackson, MS, USA.
Insights
Diuretic therapy in NICU can cause hypochloremia, an often-overlooked electrolyte imbalance linked to serious health issues. This review highlights the importance of managing hypochloremia in preterm infants receiving diuretics.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Clinical Pharmacology
Background:
- Diuretic therapy is standard in neonatal intensive care units (NICUs).
- Diuretics commonly cause electrolyte disturbances, including hyponatremia, hypokalemia, and hypochloremia.
- Hypochloremia is frequently underdiagnosed and undertreated, despite its association with adverse outcomes.
Purpose of the Study:
- To review the current literature on hypochloremia in infants undergoing diuretic therapy.
- To emphasize the clinical significance and morbidities associated with hypochloremia.
- To propose a practical management strategy for hypochloremia in preterm infants.
Main Methods:
- Systematic review of existing scientific literature.
- Analysis of clinical data and case studies concerning diuretic-induced electrolyte imbalances.
- Evaluation of therapeutic interventions for hypochloremia.
Main Results:
- Hypochloremia is linked to nephrocalcinosis, hypochloremic alkalosis, and impaired growth.
- Diuretic resistance can be exacerbated by hypochloremia, complicating fluid management.
- Standard hyponatremia management is often prioritized over hypochloremia.
Conclusions:
- Hypochloremia requires greater clinical attention in infants receiving diuretics.
- Alternative chloride supplementation strategies may be necessary.
- A pragmatic approach to managing hypochloremia is crucial for improving outcomes in preterm infants.
Abstract:
Diuretic therapy, commonly used in the newborn intensive care unit, is associated with a variety of electrolyte abnormalities such as hyponatremia, hypokalemia, and hypochloremia. Hypochloremia, often ignored, is associated with significant morbidities and increased mortality in infants and adults. Clinicians respond in a reflex manner to hyponatremia than to hypochloremia. Hypochloremia is associated with nephrocalcinosis, hypochloremic alkalosis, and poor growth. Besides, the diuretic resistance associated with hypochloremia makes maintaining chloride levels in the physiological range even more logical. Since sodium supplementation counters the renal absorption of calcium and lack of evidence for spironolactone role in diuretic therapy for bronchopulmonary dysplasia (BPD), alternate chloride supplements such as potassium or arginine chloride may need to be considered in the management of hypochloremia due to diuretic therapy. In this review, we have summarized the current literature on hypochloremia secondary to diuretics and suggested a pragmatic approach to hypochloremia in preterm infants.
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