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Review
. 2021 Feb 4:8:2333794X21991014.
doi: 10.1177/2333794X21991014. eCollection 2021.

Hypochloremia Secondary to Diuretics in Preterm Infants: Should Clinicians Pay Close Attention?

Renjithkumar Kalikkot Thekkeveedu  1 , Sumana Ramarao  1 , Nilesh Dankhara  1 , Pradeep Alur  1
Affiliations
Review

Hypochloremia Secondary to Diuretics in Preterm Infants: Should Clinicians Pay Close Attention?

Renjithkumar Kalikkot Thekkeveedu et al. Glob Pediatr Health. .

Abstract

Diuretic therapy, commonly used in the newborn intensive care unit, is associated with a variety of electrolyte abnormalities such as hyponatremia, hypokalemia, and hypochloremia. Hypochloremia, often ignored, is associated with significant morbidities and increased mortality in infants and adults. Clinicians respond in a reflex manner to hyponatremia than to hypochloremia. Hypochloremia is associated with nephrocalcinosis, hypochloremic alkalosis, and poor growth. Besides, the diuretic resistance associated with hypochloremia makes maintaining chloride levels in the physiological range even more logical. Since sodium supplementation counters the renal absorption of calcium and lack of evidence for spironolactone role in diuretic therapy for bronchopulmonary dysplasia (BPD), alternate chloride supplements such as potassium or arginine chloride may need to be considered in the management of hypochloremia due to diuretic therapy. In this review, we have summarized the current literature on hypochloremia secondary to diuretics and suggested a pragmatic approach to hypochloremia in preterm infants.

Keywords: bronchopulmonary dysplasia; diuretics; hypochloremia; metabolic alkalosis; preterm infants.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure.1.
Figure.1.
Vicious cycle of hypoventilation, hypercarbia, hypochloremic alkalosis, and hypoventilation.
Figure 2.
Figure 2.
Effects of hypochloremia at renal level.
See this image and copyright information in PMC

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