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Continuous infusion of furosemide in the treatment of patients with congestive heart failure and diuretic resistance
Author(s) -
Meyel J. J. M.,
Smits P.,
Dormans T.,
Gerlag P. G. G.,
Russel F. G. M.,
Gribnau F. W. J.
Publication year - 1994
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.1994.tb01082.x
Subject(s) - furosemide , medicine , diuretic , heart failure , digoxin , excretion , diuresis , gastroenterology , anesthesia , renal function
Objectives . To assess the value of treatment with continuous intravenous infusion of furosemide (F) in patients with refractory congestive heart failure. Design . Open uncontrolled dose‐response study. Subjects . Patients with congestive heart failure (those with New York Heart Association (NYHA) classes III and IV with an assessed amount of oedema of more than 5 kg and diuretic resistance were included [ n = 10]). Diuretic resistance was defined as: failure to lose weight and/or inappropriate urinary sodium excretion (50 mmol 24 h ‐1 ) despite bed rest for a period of 2–3 days, salt and water restriction, orally and intravenously administered furosemide in a dose of 250 mg day ‐1 , digoxin, and when possible an ACE inhibitor. Included patients were treated with continuous F infusion at a delivery rate of 20 mg ‐1 over 24 h. The infusion rate was gradually heightened up to a maximum dose of 160 mg h ‐1 . Main outcome measures . Daily physical examination, history of side‐effects, determination of serum electrolytes and 24‐h electrolyte excretion during treatment with furosemide. Results . Weight loss (mean ± sd ; 12.5 ± 5 kg) and relief of symptoms was achieved in all patients. Mean (± sd ) 24‐h sodium output rose from 19 ± 16 mmol 24 h ‐1 ( n = 10) on oral therapy with 250 mg F to 137 ± 85 mmol 24 h ‐1 ( n = 8) during 80 mg h ‐1 and to 268 ± 124 mmol 24 h ‐1 ( n = 3) on the maximal dose of 160 mg h ‐1 . Conclusion . Continuous infusion of F under careful monitoring of the patient is a safe, controllable and efficient treatment in patients with severe congestive heart failure and diuretic resistance.