Dosage and route of use

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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