title: Absence of tolerance and toxicity to high-dose continuous intravenous furosemide in haemodynamically unstable infants after cardiac surgery.
abstract: OBJECTIVE
  To evaluate a high-dose continuous furosemide regimen in infants after cardiac surgery.
  
  
  METHODS
  Fifteen haemodynamically unstable infants with volume overload admitted to a paediatric intensive care unit were treated with an aggressive furosemide regimen consisting of a loading bolus (1-2 mg kg(-1)) followed by a continuous infusion at 0.2 mg kg(-1) h(-1) which was adjusted according to a target urine output of 4 ml kg(-1) h(-1). Frequent sampling for furosemide concentrations in blood and urine was done for 3 days with simultaneous assessment of sodium excretion and urine output.
  
  
  RESULTS
  The mean furosemide dose was 0.22 (+/- 0.06), 0.25 (+/- 0.10) and 0.22 (+/- 0.11) mg kg(-1) h(-1) on the first, second and third day, respectively. Median urine production was 3.0 (0.6-5.3), 4.2 (1.7-6.6) and 3.9 (2.0-8.5) ml kg(-1) h(-1), respectively, on the first, second and third day of the study. The target urine production was reached at a median time of 24 (6-60) h and this was maintained during the study period. The regimen did not result in toxic serum concentrations and was haemodynamically well tolerated.
  
  
  CONCLUSIONS
  High-dose continuous furosemide infusion for 72 h in haemodynamically unstable infants after cardiac surgery appears to be a safe and effective treatment for volume overload. Development of tolerance against the effects of furosemide and ototoxic furosemide concentrations were not observed.
authors: Paediatric Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands.
authors: Maria M J
authors: MM
authors: van der Vorst
authors: Joana E
authors: JE
authors: Kist-van Holthe
authors: Jan
authors: J
authors: den Hartigh
authors: Albert J
authors: AJ
authors: van der Heijden
authors: Adam F
authors: AF
authors: Cohen
authors: Jacobus
authors: J
authors: Burggraaf
mesh_terms: D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D004361:Drug Tolerance / Q000502:physiology; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male
chemical_list: D005665:Furosemide