Impact of Arginine Hydrochloride Supplementation on Diuretic Effectiveness in Critically Ill Children.

Objective: Hypochloremia is common in children receiving diuretics and may contribute to diuretic -resistance. This study's objective was to investigate whether arginine hydrochloride supplementation for -hypochloremia was associated with a change in urine output (UOP) or fluid balance (FB) in children -receiving diuretics.

Methods: This was an observational retrospective study of children admitted to the pediatric, cardiac, or neonatal intensive care unit. Patients were included if they received at least 3 days of loop or thiazide diuretics then supplemented with arginine hydrochloride during ongoing diuresis. Data collected included diagnosis category, electrolyte supplementation and serum concentrations, weights, and all fluid input and output. UOP and FB were compared in the 48 hours before and after supplementation.

Results: Of the 345 children studied, 60% had underlying cardiac disease and 97% received furosemide. Median arginine hydrochloride dose was 0.9 mEq/kg, most often given every 6 hours for 4 doses. Serum chloride concentrations rose from 91.6 to 96.4 mmol/L (p < 0.001). There was no difference in UOP (4.6 vs 4.4 mL/kg/hr, p = 0.06) or FB (1.5 vs 2.7 mL/kg/day, p = 0.13) when comparing the 48 hours before supplementation with the 48 hours after. Analyses of patients with stable diuretic dosing, those with a serum chloride concentration ≤90 mmol/L, those with an increase in serum chloride ≥8 mmol/L, and those with cardiac disease had no improvement in UOP or FB after chloride supplementation.

Conclusions: Arginine hydrochloride supplementation was not associated with an improvement in diuretic effectiveness in children as demonstrated by lack of improvement in UOP or FB.