title: Comparison of the diuretic effect of furosemide mixed with human albumin or fresh frozen plasma for patients with hypoalbuminemia in the intensive care unit.
abstract: BACKGROUND
  Diuretics are commonly used in the intensive care unit (ICU) for patients with fluid over-loading. Hypoalbuminemia is a major cause of diuretic resistance. Albumin mixed with furosemide can promote diuresis and sodium excretion in patients with hypoalbuminemia. The purpose of this study is to compare the diuretic effect of furosemide (FU) mixed with human albumin (HA) or fresh frozen plasma (FFP) in ICU patients with hy-poalbuminemia.
  
  
  METHODS
  Patients with fluid overloading and hypoalbuminemia who needed diuretic treatment were enrolled and were divided into 2 groups: the first group having clearance of creatinine (CCr) >20 ml/min, and the second group having CCr < or = 20 ml/min. FU (60 mg) mixed with HA (HA group), 60 mg FU mixed with FFP (FFP group) and water (placebo group) were given intravenously to these patients for 60 minutes in random order on the first, third and fifth day. After drug administration, 8-hour urine was collected, and urine amount and urinary sodium excretion were checked.
  
  
  RESULTS
  Both the HA group and the FFP group had significantly higher urinary volume and sodium excretion than the placebo group in the patients with CCr >20 ml/min or CCr < or = 20 ml/min (p < 0.01). In the patients with CCr >20 ml/min, there was no difference in the amount of urine excretion and cumulative urinary sodium excretion between the HA group and FFP group. In the patients with CCr < or =ml;20 ml/min, the HA group had a significantly higher urine output and urinary sodium excretion than the FFP group (p < 0.05).
  
  
  CONCLUSIONS
  In ICU patients, 60 mg FU mixed with HA or FFP has a similar diuretic effect in patients with CCr >20 ml/min. FFP is an effective alternative choice for improving diuresis for ICU patients with hypoalbuminemia. In patients with CCr < or = 20 ml/min, albumin mixed with 60 mg FU has a superior diuretic effect compared with FFP mixed with FU.
authors.affiliation: Intensive Care Unit, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan-ROC. cwhsu2003@yahoo.com
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Shoa-Lin
authors.initials: SL
authors.lastname: Lin
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Sun
authors.forename: Kuo-An
authors.initials: KA
authors.lastname: Chu
authors.forename: Hsiao-Min
authors.initials: HM
authors.lastname: Chung
authors.forename: Hsueh-Wen
authors.initials: HW
authors.lastname: Chang
mesh_terms: D000328:Adult; D003404:Creatinine / Q000652:urine; D018592:Cross-Over Studies; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000008:administration & dosage*; D004351:Drug Resistance / Q000187:drug effects; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D034141:Hypoalbuminemia / Q000628:therapy* / Q000652:urine; D007362:Intensive Care Units; D008297:Male; D010949:Plasma; D011446:Prospective Studies; D012709:Serum Albumin / Q000008:administration & dosage*; D016037:Single-Blind Method; D012964:Sodium / Q000652:urine; D013997:Time Factors
chemical_list: D004232:Diuretics; D012709:Serum Albumin; D005665:Furosemide; D012964:Sodium; D003404:Creatinine