Glucocorticoids completely reverse refractory diuretic resistance in a patient with decompensated heart failure and gross edema

Diuretic resistance is not uncommon in severe congestive heart failure patients. In most cases, diuretic resistance can be overcome by intravenous administration of a high dose of loop diuretics. Here we report the use of glucocorticoids to reverse refractory diuretic resistance in a congestive heart failure patient who failed with intravenous administration of a high dose of furosemide (1000 mg/day). A 65-year-old man with a history of triple vessel disease and systolic ventricular dysfunction developed refractory diuretic resistance. The glucocorticoids slowly but dramatically reversed diuretic resistance. As a result, there was a dramatic improvement in his renal function. The maximum daily urine output was 8950 ml/day on day 8. The average daily output was 5636 ml/day. Finally, the patient lost 42 kg of his body weight. Potential mechanisms using glucocorticoids to revert diuretic resistance are also discussed.