Clinical impact of administering very high dose IV furosemide as a continuous infusion

"Very high dose furosemide continuous infusions provide a significant increase in diuresis without worsening renal function, disturbing electrolytes, or increasing the risk of ototoxicity" Wilczynski et al (2020).

Abstract:

Background: There is paucity of data evaluating the efficacy and safety of very high dose furosemide continuous infusions (≥40 mg/hr) for volume removal. This infusion is a novel strategy of loop diuretic administration that may add valuable data to current literature.

Methods: This was a retrospective chart review. Patients were eligible for inclusion if prescribed a very high dose furosemide infusion (defined as ≥40 mg/hr, up to 240 mg/hr) from April 1, 2017 to January 1, 2019 at Thomas Jefferson University Hospital. Data collected included the change in cumulative urine output, net urine output, incidence of acute kidney injury, occurrences of hypotension, electrolyte abnormalities, body weight, and ototoxicity.

Results: Twenty-two patients were included for analysis. The median change in 24-hour urine output from before to after very high dose continuous furosemide infusion increased from 1193 mL at 24 hours prior to infusion initiation to 3518 mL at 24 hours after infusion initiation (p <0.01). Serum creatinine increased 24 hours after infusion initiation but decreased within 48 hours. There were no electrolyte abnormalities. Out of 22 patients, only two had an occurrence of hypotension. No patients were reported to have ototoxicity.

Conclusion: Very high dose furosemide continuous infusions provide a significant increase in diuresis without worsening renal function, disturbing electrolytes, or increasing the risk of ototoxicity. Further studies are necessary to examine the efficacy and safety of this novel strategy.

Reference:

Wilczynski, J. A., DeCaro, M. V., Marhefka, G. D., Thoma, B. N., Varghese, S., Tchantchaleishvili, V., Austin, M. and Danelich, I. M. (2020) Very High Dose Furosemide Continuous Infusions: A Case Series. Journal of Cardiac Failure. June 5th. https://doi.org/10.1016/j.cardfail.2020.05.022. (epub ahead of print).

Safety IV catheter