Aminophylline in the treatment of fluid overload

Objective: Aminophylline has not been studied as an adjunct diuretic in cri tically ill children, Our purpose was to evaluate its use in the treatment of fluid overload in these patients. Design: Open, controlled clinical trial, Setting: Pediatric intensive care unit. Patients: Study subjects ranged from 2-46 months of age, were fluid overloa ded, and were receiving a continuous infusion of furosemide (greater than o r equal to 6 mg/kg/day), Patients with hemodynamic instability or liver dys function were excluded. Interventions: A single dose of aminophylline (6 mg/kg) was given after est ablishing baseline values. There were no additional diuretics or changes in vasoactive agents during the study. Measurements and Main Results: Urine output, creatinine clearance, and sodi um and potassium excretion were measured before and after administration of the aminophylline bolus, Heart rate and mean arterial pressure (mm Hg) wer e recorded hourly. Urine output increased by >80% (p < .01) during the firs t 2 hrs after administration of the aminophylline bolus and then returned t o baseline by 4 to 6 hrs, The change in urine output is consistent with the pharmacokinetics of aminophylline, Heart rate and mean arterial pressure e xhibited a change of <10% from baseline. Conclusions: These results suggest that aminophylline is an effective adjun ct to furosemide in increasing diuresis in critically ill children with flu id overload, The increased diuresis can be accomplished without increased r isk if drug levels are adequately monitored.