15 - Arginine Supplementation in Critically ill Pediatric Patients

Poster Number: 15
Publication Number: 15.201

Matthew D. Ballweg, University of Nebraska College of Medicine, OMAHA, NE, United States; Laura Ortmann, Children's Hospital & Medical Center, Omaha, NE, United States

Background: Diuretic therapy treats fluid overload but causes electrolyte and metabolic abnormalities that decrease efficacy and cause systemic neuromuscular and cardiovascular complications. Electrolytes are supplemented during diuretic therapy, specifically arginine hydrochloride, to maintain electrolyte levels and, anecdotally, maintain diuretic effectiveness.

Objective: Our goal of this study is to explore the effect of arginine hydrochloride on urine output (UOP) and fluid balance (FB) in patients receiving diuretic therapy. We hypothesize that the supplementation of arginine hydrochloride will lead to increased diuretic efficacy thus increased UOP and decreased FB.

Design/Methods: Retrospective single center chart review of arginine hydrochloride use in pediatric patients admitted to the intensive care unit who received supplementation with concurrent use of diuretic therapy between January 1, 2015, and April 30, 2020. Primary outcome was UOP 48 hours after supplementation compared to UOP 48 hours before. Other outcomes included electrolyte status and FB.

Results: A total of 368 patients were studied with a median (IQR) age of 3 (1-7 mo) months and 59% having primary cardiac disease. Median ICU stay was 20 days (10-15 d). Supplementation resulted in significant increases in chloride, BUN, and significant decreases in pH and bicarbonate. There was a non-significant change in median UOP in the 48 hours before supplementation compared to the 48 hours after (4.5 vs. 4.4 ml/kg/hour, p=0.22). There was no significant difference in median FB. Sub-analysis of patients whose diuretic dosing remained within +/-0.5g/kg/day resulted in an insignificant difference in both UOP (4.4 vs. 4.3 ml/kg/hour (p=0.17)) and FB (5.4 vs. 15 ml/day (p=0.016)). Sub-analysis of patients with initial chloride levels < 90 before supplementation resulted in a significant decrease in UOP (4.5 vs. 4.2 ml/kg/hour (p=0.048)). Final sub-analysis of patients with a change of chloride levels before and after supplementation greater than 8 units resulted in a nonsignificant difference in UOP (4.5 vs. 4.2 ml/kg/hour (p=0.21)).Conclusion(s): Initial review does not support the hypothesis that supplementation of arginine hydrochloride significantly increases the effectiveness of diuretic therapy in our PICU population by increasing UOP and decreasing FB after supplementation.