Frusemide in heart failure of infancy

Richardson, Heather

doi:10.1136/adc.46.248.520

Cited by 25 publications

(7 citation statements)

References 25 publications

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“…The fact that they had all been on diuretics before may also have contributed to the low urinary sodium in the control period when no diuretic was given. Richardson (1971) found a similar pattern in Na and K excretion in her study with frusemide in heart failure in infancy.…”

Section: Discussionsupporting

confidence: 60%

Bumetanide in heart failure in infancy.

Ward¹,

Lam²

1977

Archives of Disease in Childhood

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SUMMARY The effect of bumetanide in infants with congenital heart disease presenting with cardiac failure was studied. The study was divided into acute (3 days) and long-term (mean 10 5 weeks) cases. A total of 12 male infants was included in the acute study and 13 cases were evaluated in the long-term study. The dose used in the acute study (0-015 mg/kg) was suboptimal; notwithstanding, it was found to cause significant natriuresis and chloruresis. Bumetanide in doses varying in different infants from as little as 0 015 mg/kg on alternate days to as much as 0 10 mg/kg daily was shown to be an effective diuretic for long-term use. No side effects were observed in either study.Bumetanide (Burinex) is a potent loop diuretic. Although it bears some structural resemblance to frusemide, unlike the latter which is derived from sulphanilamide, bumetanide is a metanilamide derivative (Feit, 1971). In dogs it is weight for weight 40 to 60 times more active than frusemide when given intravenously and 100 times more active when given orally (Ostergaard et al., 1972). In rats, bumetanide is practically ineffective. In human studies 1 mg bumetanide was equipotent to 40 mg frusemide with regard to urinary excretion of sodium, chloride, potassium, and water (Asbury et al., 1972). In healthy volunteers the major action of bumetanide has been shown to be on the ascending limb of Henle's loop with an additional effect on the proximal tubule but no significant effect on the distal tubule (Bourke et al., 1973). In this study we evaluated the effect of bumetanide in infants with congenital heart disease presenting with cardiac failure. The usual criteria for diagnosis of cardiac failure were used (Lees, 1969 diuretic was given but a preliminary 24-hour collection of urine was obtained. Only male infants were studied in order to facilitate accurate collection of urine samples. The 24-hour urine on day 1 was used as a control and was analysed for volume, sodium, potassium chloride, calcium, magnesium, phosphate, urate, glucose, and osmolality. On day 2 the infant was weighed and a blood sample was obtained and analysed for urea, sodium, potassium, chloride, calcium, magnesium, phosphate, liver function tests (serum proteins, SGOT, SGPT, alkaline phosphatase, bilirubin), haemoglobin, white cell count, and glucose. Immediately after blood sampling bumetanide 0 f015 mg/kg (prepared by dilution of the injectable form in sterile water) was administered orally. Urine was then collected at hourly intervals for 6 hours, followed by a further 18-hour collection to complete the 24-hour urine collection for day 2. On day 3 the infant's weight was recorded again and all the haematological and biochemical tests listed above were repeated.

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Section: Discussionsupporting

confidence: 60%

Bumetanide in heart failure in infancy.

Ward¹,

Lam²

1977

Archives of Disease in Childhood

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“…However, there is insufficient data to quantify the impact of treatment with these medicines in this patient population. In the UK, oral liquid furosemide is generally administered to a small group of infants with heart failure or chronic lung disease of prematurity [ 17 , 19 ]. Neurocognitive outcomes in these two patient groups are recognised to be poor [ 11 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Essential medicines containing ethanol elevate blood acetaldehyde concentrations in neonates

et al. 2016

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Neonates administered ethanol-containing medicines are potentially at risk of dose-dependent injury through exposure to ethanol and its metabolite, acetaldehyde. Here, we determine blood ethanol and acetaldehyde concentrations in 49 preterm infants (median birth weight = 1190 g) dosed with iron or furosemide, medicines that contain different amounts of ethanol, and in 11 control group infants (median birth weight = 1920 g) who were not on any medications. Median ethanol concentrations in neonates administered iron or furosemide were 0.33 (range = 0–4.92) mg/L, 0.39 (range = 0–72.77) mg/L and in control group infants were 0.15 (range = 0.03–5.4) mg/L. Median acetaldehyde concentrations in neonates administered iron or furosemide were 0.16 (range = 0–8.89) mg/L, 0.21 (range = 0–2.43) mg/L and in control group infants were 0.01 (range = 0–0.14) mg/L. There was no discernible relationship between blood ethanol or acetaldehyde concentrations and time after medication dose.Conclusion: Although infants dosed with iron or furosemide had low blood ethanol concentrations, blood acetaldehyde concentrations were consistent with moderate alcohol exposure. The data suggest the need to account for the effects of acetaldehyde in the benefit-risk analysis of administering ethanol-containing medicines to neonates. What is Known: • Neonates are commonly treated with ethanol-containing medicines, such as iron and furosemide. • However, there is no data on whether this leads to appreciable increases in blood concentrations of ethanol or its metabolite, acetaldehyde. What is New: • In this study, we find low blood ethanol concentrations in neonates administered iron and/or furosemide but markedly elevated blood acetaldehyde concentrations in some infants receiving these medicines. • Our data suggest that ethanol in drugs may cause elevation of blood acetaldehyde, a potentially toxic metabolite.

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“…In pulmonary oedema developing in other clinical situations in the neonatal period, frusemide has been shown to be an effective diuretic (Richardson, 1971). It was therefore decided to study the effect of frusemide on blood gas tensions and fluid and electrolyte balance during the first 24 hours oflife in infants suffering from severe RDS.…”

mentioning

confidence: 99%

Frusemide in respiratory distress syndrome.

Savage¹,

Wilkinson²,

Baum³

et al. 1975

Archives of Disease in Childhood

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Archives of Disease in Childhood, 50, 709. Frusemide in respiratory distress syndrome. The effect of frusemide on urinary volume, ary sodium excretion, and urinary calcium excretion in 7 premature infants with severe respiratory distress syndrome (RDS) has been studied. The results are compared with similar measurements on 13 infants of comparable gestational age and birthweight with less severe RDS who did not receive frusemide. The effect of frusemide on Pao2 and Paco2 tensions in 5 infants with RDS was also investigated.Frusemide produced a fourfold increase in urinary volume and a tenfold increase in urinary sodium and urinary calcium excretion compared with the untreated group. It caused no improvement in blood gas tensions. The use of this diuretic for the routine management of RDS cannot be recommended.Severe interstitial oedema is found on histological examination of the lungs of infants dying from the respiratory distress syndrome (RDS) during the first few hours of life (Gandy, Jacobson, and Gairdner, 1970). In pulmonary oedema developing in other clinical situations in the neonatal period, frusemide has been shown to be an effective diuretic (Richardson, 1971). It was therefore decided to study the effect of frusemide on blood gas tensions and fluid and electrolyte balance during the first 24 hours oflife in infants suffering from severe RDS.Material and methods Two groups of infants were studied. 7 infants received frusemide and 13 infants received no diuretic and constituted an untreated group. Patients were randomly allocated to the 2 groups but were not matched for the severity of RDS. All infants had RDS according to classical criteria (Davies et al., 1972). The infants in the treated group had more severe RDS than those in the untreated group (Tables I and II). The management of the infants was that in current use in the unit, which includes umbilical arterial and venous catheterization (Davies et al., 1972). Present addresses: *Department of Paediatrics, Guy's Hospital, London. tNuffleld Institute for Medical Research, Oxford. tAddenbrooke's Hospital, Cambridge. constant inspired oxygen concentration. Blood gases were measured (using the IL 313 Blood Gas Analyser) immediately before, 20 minutes after, and 60 minutes after each dose of diuretic. They were also routinely measured 4-hourly during the first 24 hours of life.The fluid, calcium, and sodium intake of all infants was measured during the first 24 hours of life. All urine passed during this period was collected, the volume noted, and the calcium and sodium concentrations measured. Measurements were also made of plasma sodium (by flame photometry), calcium (by titrimetric method using EDTA), osmolality (Advanced osmometer), albumin (Bromocresol green colorimetry), and colloid osmotic pressure (using a pressure transducer osmometer as described by Baum et al. (1971) on cord blood and blood samples taken at 24 hours of age.The data from the 7 infants who received frusemide were compared with data derived from the 13 infants in the untre...

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Frusemide in heart failure of infancy

Cited by 25 publications

References 25 publications

Bumetanide in heart failure in infancy.

Bumetanide in heart failure in infancy.

Essential medicines containing ethanol elevate blood acetaldehyde concentrations in neonates

Frusemide in respiratory distress syndrome.

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