BNF for Children 2011-2012

82 2.2.7 Carbonic anhydrase inhibitors BNFC 2011–20122 Cardiovascular systemBreast-feeding manufacturer advises avoid unlessessential—no information availableSide-effects less commonly hypotension, thrombophlebitis,fluid and electrolyte imbalance; rarely drymouth, thirst, nausea, vomiting, oedema, raisedintracranial pressure, arrhythmia, hypertension,pulmonary oedema, chest pain, headache, convulsions,dizziness, chills, fever, urinary retention,focal osmotic nephrosis, dehydration, cramp, blurredvision, rhinitis, skin necrosis, and hypersensitivityreactions (including urticaria and anaphylaxis); veryrarely congestive heart failure and acute renal failureLicensed use not licensed for use in children under12 yearsIndication and doseCerebral oedema, raised intra-ocular pressure. By intravenous infusion over 30–60 minutesChild 1 month–12 years 0.25–1.5 g/kg repeatedif necessary 1–2 times after 4–8 hoursChild 12–18 years 0.25–2 g/kg repeated ifnecessary 1–2 times after 4–8 hoursPeripheral oedema and ascites. By intravenous infusion over 2–6 hoursChild 1 month–18 years 1–2 g/kgAdministration examine infusion for crystals; if crystalspresent, dissolve by warming infusion fluid (allowto cool to body temperature before administration);for mannitol 20%, an in-line filter is recommended(15-micron filters have been used)Mannitol (Baxter) AIntravenous infusion, mannitol 10%, net price 500-mL Viaflex c bag = £2.26, 500-mL Viaflo c bag =£2.15; 20%, 250-mL Viaflex c bag = £3.27, 250-mLViaflo c bag = £3.27, 500-mL Viaflex c bag = £3.29,500-mL Viaflo c bag = £3.122.2.6 Mercurial diureticsClassification not used in BNF for Children.2.2.7 Carbonic anhydraseinhibitorsThe carbonic anhydrase inhibitor acetazolamide is aweak diuretic although it is little used for its diureticeffect. Acetazolamide and eye drops of dorzolamide andbrinzolamide inhibit the formation of aqueous humourand are used in glaucoma (section 11.6). In children,acetazolamide is also used in the treatment of epilepsy(section 4.8.1), and raised intracranial pressure (section11.6).2.2.8 Diuretics with potassiumDiuretics and potassium supplements should be prescribedseparately for children.2.3 Anti-arrhythmic drugs2.3.1 Management of arrhythmias2.3.2 Drugs for arrhythmias2.3.1 Management ofarrhythmiasManagement of an arrhythmia requires precise diagnosisof the type of arrhythmia; electrocardiography andreferral to a paediatric cardiologist is essential; underlyingcauses such as heart failure require appropriatetreatment.Arrhythmias may be broadly divided into bradycardias,supraventricular tachycardias, and ventricular arrhythmias.Bradycardia Adrenaline (epinephrine) is useful in thetreatment of symptomatic bradycardia in an infant orchild.Supraventricular tachycardiasIn supraventricular tachycardia adenosine is given byrapid intravenous injection. If adenosine is ineffective,intravenous amiodarone, flecainide, or a beta-blocker(such as esmolol, see section 2.4) can be tried; verapamilcan also be considered in children over 1 year.Atenolol, sotalol (section 2.4), and flecainide are usedfor the prophylaxis of paroxysmal supraventriculartachycardias.The use of d.c. shock and vagal stimulation also have arole in the treatment of supraventricular tachycardia.Syndromes associated with accessory conductingpathways Amiodarone, flecainide, or a betablockeris used to prevent recurrence of supraventriculartachycardia in infants and young children with thesesyndromes (e.g. Wolff-Parkinson-White syndrome).Atrial flutter In atrial flutter without structural heartdefects, sinus rhythm is restored with d.c. shock orcardiac pacing; drug treatment is usually not necessary.Amiodarone is used in atrial flutter when structuralheart defects are present or after heart surgery. Sotalol(section 2.4) may also be considered.Atrial fibrillation Atrial fibrillation is very rare inchildren. To restore sinus rhythm d.c. shock is used;beta-blockers, alone or together with digoxin, may beuseful for ventricular rate control.Ectopic tachycardia Intravenous amiodarone is usedin conjunction with body cooling and synchronisedpacing in postoperative junctional ectopic tachycardia.Oral amiodarone or flecainide are used in congenitaljunctional ectopic tachycardia.Amiodarone, flecainide, or a beta-blocker are used inatrial ectopic tachycardia; amiodarone is preferred inthose with poor ventricular function.