Continuous furosemide infusion in the management of ascites

Nicholas A. Rogers, Samir Gupta, Jennifer A. Cuthbert

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: The current therapy for patients hospitalized with ascites requires titration of oral diuretics and often needs several days. A faster method for predicting the response to a given dose of diuretic may allow this process to be completed more rapidly. Aim: The objective of this study was to describe the short-term safety and efficacy of a diuretic infusion to predict net sodium excretion in patients with cirrhosis, ascites, and edema using a fractional excretion of sodium (FENa) of 1% or greater as the target. Methods: We conducted a retrospective case series of patients admitted for management of ascites who received intravenous furosemide by continuous infusion in ascites management. Patients were stratified depending on whether they had edema or received an intravenous bolus of furosemide or a large-volume paracentesis. The primary outcome was the proportion of patients achieving a FENa of 1% or greater during the infusion. Secondary outcomes included development of electrolyte abnormalities or acute kidney injury during or immediately following the infusion and natriuresis on titrated oral furosemide. Results: Forty-seven patients meeting criteria were identified from 721 patients seen in consultation. Ten of the patients had edema and received neither bolus intravenous diuretic therapy nor therapeutic paracentesis; all 10 achieved a FENa of 1% or greater. One patient had transient hypokalemia. Of 37 patients who either had no edema or received additional treatment options, all but 6 patients achieved a FENa of 1% or greater. Transient complications in 31 patients with natriuresis included hyponatremia (n = 1), hypokalemia (n = 5), and acute kidney injury (n = 3). Twenty-four-hour urine sodium averaged more than 4 g/d on the titrated oral furosemide regimen in 19 patients completing the collection. Conclusions: Use of a short continuous furosemide infusion can achieve a FENa of 1% or greater in patients with cirrhotic ascites and may be safe and efficacious for diuresis, meriting further study.

Original languageEnglish (US)
Pages (from-to)671-675
Number of pages5
JournalJournal of Investigative Medicine
Volume60
Issue number4
DOIs
StatePublished - Apr 2012

Fingerprint

Furosemide
Ascites
Diuretics
Sodium
Edema
Titration
Paracentesis
Electrolytes
Natriuresis
Hypokalemia
Acute Kidney Injury
Hyponatremia
Diuresis
Therapeutics
Fibrosis
Referral and Consultation

Keywords

  • Ascites
  • Edema
  • FENa
  • Fractional excretion of sodium
  • Furosemide infusion

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Continuous furosemide infusion in the management of ascites. / Rogers, Nicholas A.; Gupta, Samir; Cuthbert, Jennifer A.

In: Journal of Investigative Medicine, Vol. 60, No. 4, 04.2012, p. 671-675.

Research output: Contribution to journalArticle

Rogers, Nicholas A. ; Gupta, Samir ; Cuthbert, Jennifer A. / Continuous furosemide infusion in the management of ascites. In: Journal of Investigative Medicine. 2012 ; Vol. 60, No. 4. pp. 671-675.
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