Key result
Continuous furosemide infusion increases daily urine volume by ~600 ml over bolus injection.
Why the study?
The delivery rate of furosemide into the nephron is a determinant of diuretic efficacy in healthy volunteers, motivating a comparison of continuous infusion versus bolus injection of an equal high dose in patients with severe heart failure.
Does an 8-hour continuous infusion of high dose furosemide improve daily urinary volume and sodium excretion compared to a single intravenous bolus injection in patients with severe heart failure?
RCT (n=20)
Randomized crossover
Does an 8-hour continuous infusion of high dose furosemide improve daily urinary volume and sodium excretion compared to a single intravenous bolus injection in patients with severe heart failure?
In patients with severe heart failure, administering high-dose furosemide as an 8-hour continuous infusion produces greater diuresis and natriuresis with fewer ototoxic side effects compared to an equal-dose single intravenous bolus injection.
Supports cautious high-dose furosemide use in severe HF; leaves open optimal administration route pending randomized data.
Objectives The efficacy of high dose furosemide as a continuous infusion was compared with a bolus injection of equal dose in patients with severe heart failure. Background The delivery rate of furosemide into the nephron has been proved to be a determinant of diuretic efficacy in healthy volunteers. Methods In a randomized crossover study we compared the efficacy of a continuous infusion of high dose furosemide (mean daily dosage 690 mg, range 250 to 2,000) versus a single bolus injection of an equal dose in 20 patients with severe heart failure. The patients received an equal dosage, either as a single intravenous bolus injection or as an 8-h continuous infusion preceded by a loading dose (20% of total dosage). Results Mean (+/- SEM) daily urinary volume (infusion 2,860 +/- 240 ml, bolus 2,260 +/- 150 ml, p = 0.0005) and sodium excretion (infusion 210 +/- 40 mmol, bolus 150 +/- 20 mmol, p = 0.0045) were significantly higher after treatment with continuous infusion than with bolus injection, despite significantly lower urinary furosemide excretion (infusion 310 +/- 60 mg every 24 h, bolus 330 +/- 60 mg every 24 h, p = 0.0195). The maximal plasma furosemide concentration was significantly higher after bolus injection than during continuous infusion (infusion 24 +/- 5 micrograms/ml, bolus 95 +/- 20 micrograms/ml, p < 0.0001). Short-term, completely reversible hearing loss was reported only after bolus injection in 5 patients. Conclusions We conclude that in patients with severe heart failure, high dose furosemide administered as a continuous infusion is more efficacious than bolus injection and causes less ototoxic side effects.
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Dormans et al. (1996) conducted an RCT in Severe heart failure (n=20). Continuous infusion of high-dose furosemide vs. Single intravenous bolus injection of equal dose was evaluated on Daily urinary volume (ml) and sodium excretion (mmol) (p=0.0005). Continuous infusion of high-dose furosemide increased daily urinary volume (2,860 vs 2,260 ml, p=0.0005) and sodium excretion (210 vs 150 mmol, p=0.0045) compared with bolus injection.
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