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Hyponatremia During Arginine Vasopressin Therapy in Children Following Cardiac Surgery.
MedLine Citation:
PMID:  23392370     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: To describe the incidence and severity of hyponatremia after initiation of arginine vasopressin therapy in children recovering from cardiothoracic surgery, and to compare these patients with a control group with similar disease complexity and severity who did not receive arginine vasopressin. DESIGN:: Retrospective chart review. SETTING:: PICU at a tertiary care university hospital. PATIENTS:: Twenty-nine patients who received arginine vasopressin for at least 6 hrs during the first 48 postoperative hours following cardiothoracic surgery were compared with 47 patients who did not receive arginine vasopressin. After surgery, all patients received intravenous fluids consisting of dextrose and 0.22% saline for daily fluid requirements as well as isotonic colloid and blood products as needed for additional resuscitation. RESULTS:: Mean initial postoperative serum sodium did not differ between groups, 144.6 ± 3.4 in those patients who received arginine vasopressin and 144.5 ± 3.7 in those who did not, p = 0.969. Mean lowest sodium in the first 72 hrs, however, was 134.7 ± 3.8 in those who received arginine vasopressin as compared with 137.1 ± 4.3 in the control group, p = 0.019. Hyponatremia occurred in 14 (48%) of the patients who were received arginine vasopressin but only in 8 (17%) of the patients in the control group, p = 0.004. Mean age, weight, sex, Aristotle score, and duration of cardiopulmonary bypass were not statistically different between groups. Mean volumes of hypotonic fluids administered and cumulative diuretic dosing during the first 72 hrs post-surgery were also not statistically different between groups. CONCLUSIONS:: Hyponatremia occurred in nearly half of the infants and children receiving arginine vasopressin therapy in this study. Clinicians should be aware of this association, monitor serum sodium values closely, and consider providing less free water to these patients before hyponatremia occurs.
Authors:
Maria Caridad Davalos; Renee Barrett; Shivaprakash Seshadri; Henry L Walters; Ralph E Delius; Marwan Zidan; Christopher W Mastropietro
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-7
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  -     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, MI. 2 Department of Cardiovascular Surgery, Wayne State University/Children's Hospital of Michigan, Detroit, MI. 3 Department of Pediatrics, Division of Critical Care, Wayne State University/Children's Hospital of Michigan, Detroit, MI.
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