Introduction/background: Fluid overload is common in critically ill children and is associated with significant morbidity and mortality. Furosemide is the most widely used diuretic to manage excess fluid. In addition to loop diuretics, thiazide diuretics may be used to enhance urine output. Data and information regarding safe and effective dosing of furosemide and chlorothiazide in the critically ill pediatric population are lacking. The primary objective of this study was to compare urine output 24 hours after initiation of furosemide or chlorothiazide in critically ill children.
Methods: This was a multi-center retrospective cohort study conducted at 3 academic medical centers. Children between the ages of 1 day and 17 years that received at least one dose of intravenous or oral diuretics from February 2013 to January 2017 were included. Patients with bronchopulmonary dysplasia or on home diuretics were excluded. Only the first dose of diuretic was included in the study. Patients were divided into 2 groups: furosemide versus chlorothiazide. Urine output 24 hours prior to the diuretic was compared to urine output 24 hours after initiation of the diuretic.
Results: There were 133 patients identified who met the inclusion criteria for the study. There were 88 patients that received at least one dose of furosemide and 45 that received at least one dose of chlorothiazide. Most patients were male (49, 55.7%) with a median age of 2.3 years. The median dose for furosemide was 0.7 mg/kg and for chlorothiazide was 2.4 mg/kg. There were no statistically significant differences between baseline urine output for furosemide (2.9 ml/kg/hr) or chlorothiazide (2.8 ml/kg/hr), p=0.6. Although not statistically different, urine output 24 hours after the diuretic dose increased by 0.84 ml/kg/hr for furosemide and 0.73 ml/kg/hr for chlorothiazide, p=0.45.
Conclusion: Furosemide and chlorothiazide resulted in similar urine output changes 24 hours after an intravenous dose.