Furosemide is one of the most effective and least toxic
diuretics used in pediatric practice. Experimental and clinical data suggest that adrenocorticosteroids and/or endogenous
ouabain-like substances may play an important role in its
diuretic effect. Also, the
drug appears to have anti-inflammatory properties. In children with different diseases who received orally or intravenously 1 to 2 mg/kg doses of
furosemide, a statistically significant positive linear relationship was found between the
drug urinary excretion rate and the urine flow rate, but log dose-response curves to the
drug were found to vary depending on the disease and the route of the
drug administration. No sigmoid-shaped log dose-response curve (ie, one approaching a zero response at very low
furosemide urinary excretion rates and a maximum response at very high excretion rates) was attained, which may suggest that the capacity of the kidney tubules to respond diuretically to the aforementioned doses of
furosemide was not exceeded in these patients. However, in infants with different diseases and reasonably normal renal function who required administration of this
diuretic, a very steep log dose-response curve to a 1 mg/kg intravenous dose of
furosemide was found, which may suggest that higher doses may not result in a significant increase in
diuretic response. The lowest mean
furosemide urinary excretion rate and its concentration in urine associated with a significant diuresis were found to be 0.58 +/- 0.33 microg/kg/min and 24.2 +/- 10.5 microg/ml, respectively. Also, a significant correlation was found between the amount (in milligrams) of
furosemide excreted in the urine during the first 6 hours after administration and the urine volume collected during that time. Patients with
cystic fibrosis appeared to have a markedly more pronounced
diuretic response to the average oral dose of 0.835 +/- 0.18 mg/kg than that reported in control children given 2 mg/kg. In children with
acute renal failure caused by acute gastroenterocolitis or
glomerulonephritis, a broad relationship was observed between a single intravenous dose and
diuretic response after administration of
furosemide (1.2 to 30.8 mg/kg). It was suggested that the total daily dose of the
drug should not exceed 100 mg in these patients.
Furosemide was found to be effective in management of bronchoconstriction accompanying chronic
lung disease and narrowing of the upper respiratory airways; in
hydrocephalus in infancy to avoid
cerebrospinal fluid shunts; in some diagnostic procedures, such as an assessment of fetal and neonatal
hydronephrosis; and in evaluation of different types of
renal tubular acidosis. Among side effects accompanying clinical use of this
drug were
cholelithiasis in premature infants receiving
total parenteral nutrition concomitantly with the
diuretic;
secondary hyperparathyroidism and
bone disease in infants obtaining long-term
furosemide treatment; and
drug-induced fever.