Loop diuretics are administered parenterally in critically ill adult patients, and an initial intravenous dosage of 20 mg of furosemide is recommended. If no response is seen after 1 h, an incremental regimen is prescribed which consists of doubling the previous dose every 2 h until satisfactory response is obtained. Alternatively, a daily maximum dose of 2 g of furosemide (10 mg of bumetamide) is given.
If diuresis does not occur after an intravenous bolus of loop diuretics, a continuous infusion can be used. The rationale, based on a number of studies, is that a controlled infusion of furosemide or bumetamide results in greater natriuresis and diuresis than an equivalent dosage administered intermittently. A better efficacy at the diuretic receptor level may explain this improvement. The starting dose is around 2 mg/h of furosemide, titrated every hour until the response is satisfactory, with a maximum of 40 mg/h (Martin ^ The advantages of initiating therapy with a loading dose still need to be determined. A continuous-infusion strategy may also be used when a normal response to bolus injection is seen, when less hemodynamic variation is important, or when a lower total dose of diuretic is essential.
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