Acute hemodynamic and neurohoromonal effects of furosemide in critically ill pediatrics patients.
OBJECTIVE
To study the acute hemodynamic effects of furosemide in critically ill pediatrics patients, the temporal relationship between hemodynamic changes and changes in neuroendocrine axis, and the temporal relationship between hemodynamic changes and urine output.


METHODS
Prospective study.


METHODS
Pediatric intensive care unit in a tertiary care university center.


METHODS
Fourteen critically ill pediatric patients who clinically required diuretic therapy.


METHODS
Before and after furosemide administration, hemodynamic and neurohormonal measurements were taken.


RESULTS
Hemodynamic and neurohormonal responses to acute diuretic therapy were measured in 14 pediatric patients treated with furosemide (1 mg/kg/dose). Cardiac index deteriorated by 10 mins after drug administration (-9.4+/-3.9%, p<.05) and was associated with an increase in systemic vascular resistance (17.1+/-4.8%, p<.05). There was a subsequent increase in cardiac index (20+/-4.9%, p<.05) at 30 mins, with a decrease in systemic vascular resistance (-11.5+/-5.2%, p<.05). These hemodynamic changes were associated with marked increases in renin and norepinephrine concentrations and an increase in urinary prostaglandin release. The hemodynamic and neurohormonal effects had their onset before maximum diuresis.


CONCLUSIONS
Intravenous furosemide administration in acutely ill pediatric patients results in an acute but transient deterioration in cardiac function that appears to parallel the neuroendocrine changes rather than the acute diuresis.
Yetman
A T
AT
Department of Pediatirics, Children's Hospital of Western Ontario, Canada.
Singh
N C
NC
Parbtani
A
A
Loft
J A
JA
Linley
M A
MA
Johnson
C C
CC
Morgan
D
D
D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies
D004232:Diuretics; D005665:Furosemide