title: Continuous infusion of furosemide in the treatment of patients with congestive heart failure and diuretic resistance.
abstract: OBJECTIVE
  To assess the value of treatment with continuous intravenous infusion of furosemide (F) in patients with refractory congestive heart failure.
  
  
  METHODS
  Open uncontrolled dose-response study.
  
  
  METHODS
  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.
  
  
  METHODS
  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 +/- 124 mmol 24 h-1 (n = 3) on the maximal dose of 160 mg h-1.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pharmacology, University of Nijmegen, Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Meyel
authors.forename: P
authors.initials: P
authors.lastname: Smits
authors.forename: T
authors.initials: T
authors.lastname: Dormans
authors.forename: P G
authors.initials: PG
authors.lastname: Gerlag
authors.forename: F G
authors.initials: FG
authors.lastname: Russel
authors.forename: F W
authors.initials: FW
authors.lastname: Gribnau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D005665:Furosemide