Abstract
Cholestyramine is recommended in the management of intractable diarrhea, cholestatic liver disease, and hypercholesterolemia. We observed an infant receiving cholestyramine because of neonatal hepatitis who developed severe hypernatremia (175 mEq/L) and hyperchloremia (145 mEq/L) during a period of increased gastrointestinal and insensible losses from intercurrent illness. We have since observed 2 infants on cholestyramine who developed similar, less severe biochemical abnormalities.
Cholestyramine is an anion exchange resin containing 4 mEq/gm of chloride. Bile acids and other anions are exchanged in the gut for the chloride, most of which is absorbed and excreted by the kidney. In addition, we have determined that about 5 ml of water are necessary per gram of powder (∼440 mg of resin) to acquire the consistency of a normal infant's stool. Thus, unless extra water is provided to compensate for both the increase in solute load and the hydration of cholestyramine, the obligatory loss of fluid will lead to hyperchloremia and hypernatremia and a hyperosmolar state will develop. Newborns or infants with chronic disease who may not be able to concentrate the urine maximally are at highest risk. When cholestyramine therapy is indicated, it is therefore important to modify the diet such as to either decrease the solute load or provide additional water.
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Primack, W., Gartner, L., Mcgurk, H. et al. HYPERCHLOREMIA AND HYPERNATREMIA ASSOCIATED WITH CHOLESTYRAMINE THERAPY. Pediatr Res 11, 520 (1977). https://doi.org/10.1203/00006450-197704000-00902
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DOI: https://doi.org/10.1203/00006450-197704000-00902
