Spironolactone effect on potassium supplementation in paediatric cardiac intensive care patients.

WHAT IS KNOWN: Spironolactone is used in paediatric patients with heart disease, yet few data are available regarding the impact on potassium supplementation.

OBJECTIVE: We sought to determine the effect of spironolactone on potassium supplementation in paediatric cardiac intensive care patients.

METHODS: A retrospective, propensity matched cohort study was designed. Patients were included in the study if they received furosemide therapy in the cardiac intensive care unit at our institution. Patients who received spironolactone were matched to patients who did not receive spironolactone. Data collection included patient demographics, diuretic data, potassium monitoring, and total milliequivalents of potassium administered during the cardiac intensive care unit stay.

RESULTS AND DISCUSSION: A total of 448 patients met study criteria median age 0.43 (IQR 0.06-3.52) years, 58.9% male. Intensive care unit length of stay was 7 (IQR 3-17) days, cardiovascular surgery occurred in 90.4%. Patients had a mean 4.6±2.6 potassium concentrations assessed per day (29.5%±19.4%<3.5 mmol/L, and 2.9%±6.5%>5.5 mmol/L). Patients received a median of 5.1 mEq/kg (0-323.4 mEq/kg) of potassium. Spironolactone (n=224) was administered for 2 days (IQR 1-4) at mean dose of 0.64±0.54 mg kg-1  d-1 . Median total mEq/kg of potassium administered did not differ between groups (4.6 mEq/kg (IQR 0.66-16.8) vs 6.5 mEq/kg (IQR 1.3-18.3 mEq/kg), P=.13). Potassium laboratory values did not differ in hypokalemia (27.8%±19.1% vs 31.2%±19.5%, P=.06) or hyperkalemia (2.8%±5.4% vs 3.2%±7.5%, P=.49) between groups.

WHAT IS NEW: Spironolactone supplementation did not reduce the need for potassium supplementation in paediatric cardiac intensive care patients.

CONCLUSION: The routine use of spironolactone in the paediatric cardiac intensive care population may not be more efficacious than potassium supplementation for maintenance of serum potassium concentrations.