The effect of metoclopramide administration on electrolyte status and activity of renin-angiotensin-aldosterone system in premature infants

Abstract

The present study has been carried out to define whether endogenous dopamine contributes to the regulation of renal sodium handling and the function of the renin-angiotensin-aldosterone system in low birth weight premature infants. Twelve premature infants with mean birth weight of 1420 g and mean gestational age of 29.2 wk were given metoclopramide (MTC) in a dose of 0.1 mg/ kg/day to treat delayed gastric emptying, regurgitation, and abdominal distension at the age of 17-23 days. Infants were kept on either a low (2-3 mEq/kg/day) or high (4-7 mEq/kg/day) sodium diet to modulate activity of RAAS. Prior to and after a 3-day period of MTC administration, blood samples were taken, and in six male infants 24-h urine collections were made to determine plasma and urine electrolytes, plasma renin activity, plasma aldosterone concentration, and urinary aldosterone excretion. We demonstrated that plasma sodium and potassium concentrations and plasma renin activity were not altered by MTC. On the other hand, in response to MTC, there was a significant increase in urinary sodium excretion (1.8 ± 0.3 versus 2.3 ± 0.3 mEq/kg/day) and a decrease in potassium excretion (1.2 ± 0.2 versus 0.8 ± 0.1 mEq/kg/day); plasma aldosterone concentration and urinary aldosterone excretion decreased significantly from initial values of 2101 ± 274 pg/ ml and 2.91 ± 0.52µg/day to 1500 ± 207 pg/ml (p < 0.01) and 2.21 ± 0.43 µg/day (p < 0.01), respectively, after MTC. These alterations were independent of the pretreat-ment hormone levels. We conclude that in low birth weight premature infants endogenous dopamine has no influence on plasma renin activity and enhances rather than inhibits aldosterone production and renal tubular sodium reabsorption. © 1985 International Pediatric Research Foundation, Inc.