Potenciais alterações eletrolíticas relacionadas ao uso de medicamentos por pacientes em terapia intensiva neonatal

Abstract

Introduction: Critically neonatal patients are more vulnerable to damage from electrolyte changes and use many medications that can cause them. In the context of neonatal intensive care, clinically delicate conditions associated with abnormal serum concentrations of calcium, potassium, sodium and magnesium are common. The occurrence of these adverse events potentially associated with the use of antimicrobials, diuretics, corticosteroids and proton pump inhibitors is highlighted. Objective: To characterize changes in the electrolyte balance of critically ill neonates related to medication use. Methodology: Analytical, longitudinal and prospective study aimed at evaluating electrolyte changes caused by the use of medications in the Neonatal Intensive Care Unit of Maternity School Januário Cicco (MEJC). To characterize the electrolyte profile, serum concentrations of sodium, potassium, calcium, magnesium and the time of blood sample collection were evaluated.Related to medications that alter electrolytes, the number of medications administered, the type of medication, route of administration, dosage and electrolyte content present in the formulation in mEq or mg will be investigated. The variables will be obtained daily through consultation of the institution's electronic records. Results: 336 newborns were included in the study. The newborns presented gestational age of 33.8 ± 4.0 weeks, with respiratory problems associated with prematurity being the main admission diagnosis (67.5%). After analyzes, initially, related to serum potassium (K+ ), the mean serum K+ concentration in the first 30 days of hospitalization was 4.4 ± 0.3 mEq/L (95% CI 4.2 – 4.5) and the occurrence of hypokalemia is more common when compared to hyperkalemia. The model identified dopamine, norepinephrine and dobutamine as related to the tendency for increased serum K+ levels (respectively β=0,449; SE = 0,206; p=0,029; β=1,075; SE = 0,287; p=0,001; β= 0,283; SE = 0,145; p=0,050). Conclusion: The vasoactive amines dopamine, norepinephrine and dobutamine were identified as associated with elevated serum K+ levels, highlighting norepinephrine as having the greatest potential for a clinically relevant change.