PEDIATRICS Vol. 74 No. 5 November 1984, pp. 872-875
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Efficacy of Metolazone and Furosemide in Children with Furosemide-Resistant Edema

Watson C. Arnold MD1

1 From the Department of Pediatrics, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock

The effect of a combination of metolazone (0.2 to 0.4 mg/kg/d) and furosemide (2 to 4 mg/kg/d) in achieving a natriuresis and diuresis was measured in 14 children during 22 episodes of edema resistant to furosemide alone. Urinary volume increased from 24 ± 14 mL/kg/d for patients receiving furosemide to 51 mL/kg/d with combined diuretic therapy (P < .01), and sodium excretion increased from 34 ± 5 mEq/d to 155 ± 176 mEq/d (P < .01). Two children with severe hypoalbuminemia (serum albumin level <1.5 g/dL) and normal renal function, and five children with chronic renal insufficiency (71%) did not respond to combined diuretic therapy. The combination of furosemide and metolazone offers a useful and effective oral therapy in most children with edema resistant to furosemide. Children with chronic renal insufficiency and furosemide-resistant edema did not respond to combination diuretic therapy.

Key Words: nephrotic syndrome • diuretics • furosemide • metolazone • edema

Accepted on February 14, 1984


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