Jacquelyn R. Evans

Addition of Epinephrine (Epi) to Dopamine (DA) Increases Blood Pressure (BP) and Urine Output (Uv) in Critically Ill Extremely Low Birthweight Neonates(ELBW) with Uncompensated Shock † 1131

Critically ill ELBW may present with systemic hypotension and oliguria/anuria unresponsive to combined DA and dobutamine (DOB) administration at “conventional” doses (20-30 μg/kg/min). In such cases, further escalation of DA treatment or addition of Epi infusion(with or without administration of stress doses of hydrocortisone) may be effective in the management of systemic hypotension. However, the addition of Epi carries the theoretical risk of severe alpha receptor-mediated renal vasoconstriction, resulting in further decreases in Uv. Since no data are available on the potential oliguric effect of Epi in the neonate, we reviewed the cardiovascular and renal response to Epi in 5 ELBW (GA=26.6±2.3 weeks; BW=894±183 g; postnatal age=23.2±12.4 days) who received the drug at a dose range of 0.05-0.3 μg/kg/min, when DA alone (14-26μg/kg/min, n=2) or in combination with DOB (10-15 μg/kg/min, n=3) failed to increase BP effectively (Table, mean±SD,(range); *=P 0.05). However, in the 3 patients with the lowest Uv during the Pre-Epi period (Uv<2.0 mL/kg/hour), Epi increased Uv significantly. Total volume administration was unchanged during the two periods (7±2 vs 7.1±1.2 mL/kg/h). DOB was weaned off in 2 of the 3 ELBW within 2 hours of Epi treatment. Three of the patients survived.

Fluid, Electrolyte, and Acid–Base Balance

• Many pathologic states in the neonate are associated with disruptions in normal body fluid, electrolyte, and acid–base balance, which at times may in themselves be life threatening.

Administration of Large Doses of Tromethamine (THAM) Causes Pseudohyponatremia in Addition to Dilutional Hyponatremia in Critically III Preterm and Term Neonates † 1130

Administration of Large Doses of Tromethamine (THAM) Causes Pseudohyponatremia in Addition to Dilutional Hyponatremia in Critically III Preterm and Term Neonates † 1130