CONTINUOUS-INFUSION OF FUROSEMIDE IN THE TREATMENT OF PATIENTS WITH CONGESTIVE-HEART-FAILURE AND DIURETIC RESISTANCE

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+/-124mmol 24h(-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.