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Continuous Furosemide Infusion in the Management of Ascites
  1. Nicholas A. Rogers, MD,
  2. Samir Gupta, MD, MSCS,
  3. Jennifer A. Cuthbert, MD
  1. From the Parkland Memorial Hospital, Parkland Health and Hospital System, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX.
  1. Received November 21, 2011, and in revised form December 23, 2011.
  2. Accepted for publication December 29, 2011.
  3. Reprints: Jennifer A. Cuthbert, MD, Division of Digestive and Liver Diseases, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9139. E-mail: jennifer.cuthbert{at}utsouthwestern.edu.
  4. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.jinvestigativemed.com).

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.

Key Words
  • ascites
  • edema
  • furosemide infusion
  • fractional excretion of sodium
  • FENa

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