Continuous infusion of furosemide in the treatment of patients with congestive heart failure and diuretic resistance

Objectives. To assess the value of treatment with continuous intravenous infusion of furosemide (F) in patients with refractory congestive heart failure. Design. Open uncontrolled dose-response study. Subjects. Patients with congestive heart failure (those with New York Heart Association (NYHA) classes III and IV with an assessed amount of oedema of more than 5 kg and diuretic resistance were included [n = 10]). Diuretic resistance was defined as: failure to lose weight and/or inappropriate urinary sodium excretion (50 mmol 24 h-1) despite bed rest for a period of 2–3 days, salt and water restriction, orally and intravenously administered furosemide in a dose of 250 mg day-1, digoxin, and when possible an ACE inhibitor. Included patients were treated with continuous F infusion at a delivery rate of 20 mg-1 over 24 h. The infusion rate was gradually heightened up to a maximum dose of 160 mg h-1. Main outcome measures. Daily physical examination, history of side-effects, determination of serum electrolytes and 24-h electrolyte excretion during treatment with furosemide. Results. Weight loss (mean ± sd; 12.5 ± 5 kg) and relief of symptoms was achieved in all patients. Mean (± sd) 24-h sodium output rose from 19 ± 16 mmol 24 h-1 (n = 10) on oral therapy with 250 mg F to 137 ± 85 mmol 24 h-1 (n = 8) during 80 mg h-1 and to 268 ± 124 mmol 24 h-1 (n = 3) on the maximal dose of 160 mg h-1. Conclusion. Continuous infusion of F under careful monitoring of the patient is a safe, controllable and efficient treatment in patients with severe congestive heart failure and diuretic resistance.