PGY2 Pediatric Pharmacy Resident, The University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
Department of Pharmacy: Clinical and Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
Ann Pharmacother. 2023 Mar;57(3):259-266. doi: 10.1177/10600280221103576. Epub 2022 Jun 17.
Vasopressin is increasingly used in infants following cardiac surgery. Hyponatremia is a noted adverse event, but incidence and risk factors remain undefined.
The primary objective was to identify the incidence of vasopressin-induced hyponatremia. Secondary objectives included comparing baseline and change in serum sodium concentrations between infants receiving vasopressin with and without hyponatremia, and comparing vasopressin dose, duration, and clinical characteristics in those with and without hyponatremia.
This Institutional Review Board-approved, retrospective case-control study included infants <6 months following cardiac surgery receiving vasopressin for ≥6 hours at a tertiary care, academic hospital. Patients who developed hyponatremia, cases, were matched to controls in a 1:2 fashion. Demographics and clinical characteristics were collected. Descriptive and inferential statistics were employed. A conditional logistic regression was used to assess odds of hyponatremia.
Of the included 142 infants, 20 (14.1%) developed hyponatremia and were matched with 40 controls. There was significant difference in median nadir between controls and cases, 142.0 versus 128.5 mEq/L (<0.001). A significantly higher number of cases received corticosteroids, loop diuretics, and chlorothiazide versus controls. The regression analysis demonstrated that each additional hour of vasopressin increased the odds of developing hyponatremia by 5% (adjusted odds ratio 1.05 [confidence interval 1-1.1]).
Vasopressin-induced hyponatremia incidence was <15%. Vasopressin duration was independently associated with hyponatremia development.
加压素在心脏手术后的婴儿中越来越多地被使用。低钠血症是一种明显的不良事件，但发病率和危险因素仍未确定。
主要目的是确定加压素诱导的低钠血症的发病率。次要目标包括比较接受加压素治疗且无低钠血症的婴儿与接受加压素治疗且有低钠血症的婴儿的血清钠浓度的基线和变化，以及比较有和无低钠血症的婴儿的加压素剂量、持续时间和临床特征。
这项经机构审查委员会批准的回顾性病例对照研究包括在一家三级保健学术医院接受加压素治疗≥6 小时的<6 个月大的心脏手术后婴儿。发生低钠血症的患者为病例，以 1:2 的比例与对照组相匹配。收集人口统计学和临床特征。采用描述性和推断性统计进行分析。采用条件逻辑回归评估低钠血症的可能性。
在纳入的 142 名婴儿中，20 名（14.1%）发生低钠血症，并与 40 名对照组相匹配。对照组和病例组的中位数最低值有显著差异，分别为 142.0 和 128.5 mEq/L（<0.001）。与对照组相比，有更多的病例接受了皮质类固醇、袢利尿剂和氯噻嗪。回归分析表明，每增加 1 小时的加压素，发生低钠血症的可能性增加 5%（调整后的优势比 1.05[置信区间 1-1.1]）。
加压素诱导的低钠血症发生率<15%。加压素持续时间与低钠血症的发生独立相关。
