Publication date: 2018-06-09 05:51
Francis GS et al. described how administration of furosemide actually led to decreased LV function, increased LV filling pressures, increases in MAP, SVR, plasma renin activity, and plasma norepinephrine levels. 6 Essentially, furosemide led to activation of the neurohormonal system instead of turning it off.
Thanks Dr. Swami for an awesome review. This issue is a constant battel specially with older physicians who would slam a 675mg of lasix as soon the the APE pt gets through the door. But it makes sense that early on presentation Lasix has no role in the tx of APE.
Doses of 6—9 mg/kg PO, given 6—7 times daily, have been used in this population for various indications. Initial doses should not exceed 7 mg/kg. Bioavailability is variable.
A. Document, withdraw, and notify doctor.
B. Decrease mannitol flow.
C. Provide comfort measures.
D. Increase mannitol flow.
During long-term treatment with furosemide, a high-potassium diet is recommended. You may also require potassium supplements. Your doctor will monitor your potassium levels through occasional blood tests.
There are SOME patients that benefit from Lasix, however these patients are usually pretty obvious clinically. They are frankly edematous, have a more gradual decompensation, have a history consistent with gradual fluid accumulation, and are by and large relatively normotensive. Check out the Chatti article here for a great review. http:///p9mPlb-N
Rare: eosinophilia, leukopenia, bone marrow depression which necessitates withdrawal of treatment. The hematopoietic status should be therefore regularly monitored.
Pregnancy Category C - Furosemide has been shown to cause unexplained maternal deaths and abortions in rabbits at 7, 9 and 8 times the maximal recommended human dose. There are no adequate and well-controlled studies in pregnant women. LASIX should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
95 mg IV given immediately before whole blood transfusions was found to prevent a significant increase in pulmonary capillary wedge pressure (PCWP) in 7 small prospective trials of patients with chronic severe anemia. In both trials, 6 unit of whole blood was administered at a rate of 5 mL/minute in the furosemide groups with no observed increase in PCWP after the transfusion. The control group received 6 unit of whole blood at a rate of 5 mL/minute in the first trial and 7, 5, or 65 mL/minute in the second trial. The authors reported an increase in PCWP in all control groups after the transfusions.
Impact of Intravenous Loop Diuretics on Outcomes of Patients Hospitalized with Acute Decompensated Heart F ailure: Insights from the ADHERE Registry.