Subscribe to RSS
DOI: 10.1055/s-0040-1722598
Frequency and Severity of Chlorothiazide-Induced Hyponatremia in the Neonatal Intensive Care Unit
Funding None.![](https://www.thieme-connect.de/media/ajp/202212/lookinside/thumbnails/10-1055-s-0040-1722598_200643-1.jpg)
Abstract
Objective Although thiazide diuretics are commonly used in the neonatal intensive care unit (NICU), the risk of thiazide-induced hyponatremia in infants has not been well documented. The primary objective of this study was to determine the frequency and severity of hyponatremia in neonates and infants receiving enteral chlorothiazide. Secondary objectives included identifying: (1) percent change in serum sodium from before chlorothiazide initiation to nadir, (2) time to reach nadir serum sodium concentration, and (3) percentage of patients on chlorothiazide receiving sodium supplementation.
Study Design This was a retrospective cohort study of NICU patients admitted between July 1, 2014, and July 31, 2019, who received ≥1 dose of enteral chlorothiazide. Mild, moderate, and severe hyponatremia were defined as serum sodium of 130 to 134 mEq/L, 120 to 129 mEq/L, and less than 120 mEq/L, respectively. Data including serum electrolytes, chlorothiazide dosing, and sodium supplementation were collected for the first 2 weeks of therapy. Descriptive and inferential statistics were performed in SAS software, Version 9.4.
Results One hundred and seven patients, receiving 127 chlorothiazide courses, were included. The median gestational age at birth and postmenstrual age at initiation were 26.0 and 35.9 weeks, respectively. The overall frequency of hyponatremia was 35.4% (45/127 courses). Mild, moderate, and severe hyponatremia were reported in 27 (21.3%), 16 (12.6%), and 2 (1.6%) courses. The median percent decrease in serum sodium from baseline to nadir was 2.9%, and the median time to nadir sodium was 5 days. Enteral sodium supplements were administered in 52 (40.9%) courses. Sixteen courses (12.6%) were discontinued within the first 14 days of therapy due to hyponatremia.
Conclusion Hyponatremia occurred in over 35% of courses of enteral chlorothiazide in neonates and infants. Given the high frequency of hyponatremia, serum sodium should be monitored closely in infants receiving chlorothiazide. Providers should consider early initiation of sodium supplements if warranted.
Key Points
-
One-third of infants on chlorothiazide develop hyponatremia.
-
Nadir serum sodium typically occurs within 5 days.
-
Monitor sodium closely after chlorothiazide initiation.
Publication History
Received: 21 July 2020
Accepted: 02 December 2020
Article published online:
06 January 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Laughon MM, Chantala K, Aliaga S. et al. Diuretic exposure in premature infants from 1997 to 2011. Am J Perinatol 2015; 32 (01) 49-56
- 2 Bamat NA, Kirpalani H, Feudtner C. et al. Medication use in infants with severe bronchopulmonary dysplasia admitted to United States children's hospitals. J Perinatol 2019; 39 (09) 1291-1299
- 3 Storey C, Dauger S, Deschenes G. et al. Hyponatremia in children under 100 days old: incidence and etiologies. Eur J Pediatr 2019; 178 (09) 1353-1361
- 4 Isemann B, Mueller EW, Narendran V, Akinbi H. Impact of early sodium supplementation on hyponatremia and growth in premature infants: a randomized controlled trial. JPEN J Parenter Enteral Nutr 2016; 40 (03) 342-349
- 5 Baraton L, Ancel PY, Flamant C, Orsonneau JL, Darmaun D, Rozé JC. Impact of changes in serum sodium levels on 2-year neurologic outcomes for very preterm neonates. Pediatrics 2009; 124 (04) e655-e661
- 6 Hix JK, Silver S, Sterns RH. Diuretic-associated hyponatremia. Semin Nephrol 2011; 31 (06) 553-566
- 7 Chow KM, Szeto CC, Wong TY, Leung CB, Li PK. Risk factors for thiazide-induced hyponatraemia. QJM 2003; 96 (12) 911-917
- 8 Huang CC, Chung CM, Hung SI. et al. Clinical and genetic factors associated with thiazide-induced hyponatremia. Medicine (Baltimore) 2015; 94 (34) e1422
- 9 Lavagno C, Milani GP, Uestuener P. et al. Hyponatremia in children with acute respiratory infections: a reappraisal. Pediatr Pulmonol 2017; 52 (07) 962-967
- 10 Hwang KS, Kim GH. Thiazide-induced hyponatremia. Electrolyte Blood Press 2010; 8 (01) 51-57
- 11 Thomas Reuters editorial staff. Neofax 2011. 24th ed.. Monvale, NJ: Thomas Reuters; 2011
- 12 Orth LE, O'Mara KL. Impact of early versus late diuretic exposure on metabolic bone disease and growth in premature neonates. J Pediatr Pharmacol Ther 2018; 23 (01) 26-33
- 13 Jochum F, Moltu SJ, Senterre T, Nomayo A, Goulet O, Iacobelli S. ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: fluid and electrolytes. Clin Nutr 2018; 37 (6, pt. B): 2344-2353
- 14 Hoffman DJ, Gerdes JS, Abbasi S. Pulmonary function and electrolyte balance following spironolactone treatment in preterm infants with chronic lung disease: a double-blind, placebo-controlled, randomized trial. J Perinatol 2000; 20 (01) 41-45
- 15 Stewart A, Brion LP, Ambrosio-Perez I. Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev 2011; 9 (09) CD001817
- 16 Segar JL. Neonatal diuretic therapy: furosemide, thiazides, and spironolactone. Clin Perinatol 2012; 39 (01) 209-220
- 17 Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced severe hyponatremia. Review and analysis of 129 reported patients. Chest 1993; 103 (02) 601-606