14. Severe electrolyte disorders after overdosing of furosemide, spironolactone and captopril in infants with congenital heart defects: A case series

Dang Thi Hai Van, Bui Thi Khanh Ngoc

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Abstract

Six cases of severe electrolyte disorders with acute kidney failure after overdosing on furosemide, spironolactone and captopril were reported. All of them were less than  six months of age with congenital heart defects and were treated by cardiologists with a dosage of less than 2mg/kg of furosemide, spironolactone, and captopril per day. However, their parents gave them the wrong dose, as a result, all children received higher doses of both furosemide (8.8 – 13.3mg/kg/day), spironolactone and captopril (5.5 – 8.3mg/kg/day). This led to severe hyponatremia, hyperkalemia, and acute kidney injury. All six patients were treated and eventually recovered without any complication.

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References

1. Wren C, Irving CA, Griffiths JA, et al. Mortality in infants with cardiovascular malformations. Eur J Pediatr. 2012; 171(2): 281-287. doi:10.1007/s00431-011-1525-3.
2. Wik G, Jortveit J, Sitras V, Døhlen G, Rønnestad AE, Holmstrøm H. Severe congenital heart defects: incidence, causes and time trends of preoperative mortality in Norway. Arch Dis Child. 2020; 105(8): 738-743. doi:10.1136/archdischild-2019-317581
3. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145(18): e895-e1032. doi:10.1161/CIR.0000000000001063.
4. Kirk R, Dipchand AI, Rosenthal DN, et al. The International Society for Heart and Lung Transplantation Guidelines for the management of pediatric heart failure: Executive summary. J Heart Lung Transplant. 2014; 33(9): 888-909. doi:10.1016/j.healun.2014.06.002.
5. Arampatzis S, Funk GC, Leichtle AB, et al. Impact of diuretic therapy-associated electrolyte disorders present on admission to the emergency department: a cross-sectional analysis. BMC Med. 2013; 11: 83. doi:10.1186/1741-7015-11-83.
6. Dolovich L, Gavura S, Pottie K. Hyperkalemia associated with spironolactone therapy. Can Fam Physician. 2005;51(3):357-360. Accessed September 29, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472969/
7. Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced Severe Hyponatremia: Review and Analysis of 129 Reported Patients. CHEST. 1993; 103(2): 601-606. doi:10.1378/chest.103.2.601.
8. Knochel JP. Diuretic-induced hypokalemia. Am J Med. 1984; 77(5): 18-27. doi:10.1016/S0002-9343(84)80004-2.
9. Pacifici GM. Clinical Pharmacology of Furosemide in Neonates: A Review. Pharmaceuticals. 2013; 6(9): 1094-1129. doi:10.3390/ph6091094.
10. Wimmer M, Bachl G, Schlemmer M, Stiskal A. [Experiences with aldactone in pediatric cardiology (author’s transl)]. Padiatr Padol. 1979; 14(4): 363-372.
11. Buck ML. Clinical Experience with Spironolactone in Pediatrics. Ann Pharmacother. 2005; 39(5): 823-828. doi:10.1345/aph.1E618.
12. Ellison DH. Clinical Pharmacology in Diuretic Use | American Society of Nephrology. Nephropharmacology Clin. 2019; 14: 1248-1257. doi:10.2215/CJN.09630818.
13. Momma K. ACE Inhibitors in Pediatric Patients with Heart Failure. Pediatr Drugs. 2006; 8(1): 55-69. doi:10.2165/00148581-200608010-00005.
14. Ogawa K, Kawachi F, Mori T, Hishitani T, Hoshino K. Electrolyte Imbalance Caused by Diuretic Therapy in Infants with Congenital Heart Diseases. Pediatr Ther. 2017; 07(01). doi:10.4172/2161-0665.1000313.
15. Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia-February 2016 article. GOV.UK. Accessed September 29, 2022. https://www.gov.uk/drug-safety-update/spironolactone-and-renin-angiotensin-system-drugs-in-heart-failure-risk-of-potentially-fatal-hyperkalaemia.