This document discusses causes and treatment of refractory edema. It defines refractory edema as edema resistant to typical doses of loop diuretics. Causes of refractory edema include inadequate diuretic dosing, decreased absorption or secretion of diuretics, enhanced sodium reabsorption, high salt intake, and drugs interfering with diuretics. Treatment involves a stepwise approach starting with intensifying oral diuretics, adding combination diuretic therapy, intravenous bolus diuretic therapy, and continuous infusion if responsive. Patients unresponsive to intravenous diuretics may benefit from ultrafiltration. Maintaining a supine posture can also improve diuretic response.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/_i1H_i3tOuw
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https://youtu.be/SYmZ9CmmN5g
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Rheumatological aspects in hemodialysis Samar Tharwat
Dr.Samar Tharwat ,Lecturer of Internal Medicine (Rheumatology & Immunology )represents a lecture on rheumatological manifestations in patients with chronic renal failure and on hemodialysis.
Theodoros Katsivas, MD (UC San Diego Owen Clinic), Shira Abeles, MD (UC San Diego Owen Clinic) and Robyn Cunard, MD (UC San Diego) present "Renal Disease in HIV/AIDS"
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/_i1H_i3tOuw
Arabic Language version of this lecture is available at:
https://youtu.be/SYmZ9CmmN5g
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Rheumatological aspects in hemodialysis Samar Tharwat
Dr.Samar Tharwat ,Lecturer of Internal Medicine (Rheumatology & Immunology )represents a lecture on rheumatological manifestations in patients with chronic renal failure and on hemodialysis.
Theodoros Katsivas, MD (UC San Diego Owen Clinic), Shira Abeles, MD (UC San Diego Owen Clinic) and Robyn Cunard, MD (UC San Diego) present "Renal Disease in HIV/AIDS"
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/AtiaKPIdzAQ
Arabic Language version of this lecture is available at:
https://youtu.be/2cwyPcRDGEY
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This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/Nl2xKEmvRWk
Arabic Language version of this lecture is available at:
https://youtu.be/K14fWBNdEco
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WHAT IS DIURETIC RESISTANCE?How to Tackle Congestion in Heart Failure?Renal handling of sodium and water.Adverse effects of major diuretics.There are two forms diuretic tolerance
Pathophysiology and mechanisms of loop diuretic resistance.Combination Diuretic Therapy. IV Diuretic .
Isolated ultrafiltration
Antibiotic dose modification is crucial on patients with CRRT with sepsis and MOF. This talk highlights the importance of achieving plasma therapeutic drug concentration in ICU patients to enhance their chances of survival while on CRRT
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/AtiaKPIdzAQ
Arabic Language version of this lecture is available at:
https://youtu.be/2cwyPcRDGEY
- Visit our website for more lectures: www.NephroTube.com
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This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/Nl2xKEmvRWk
Arabic Language version of this lecture is available at:
https://youtu.be/K14fWBNdEco
- Visit our website for more lectures: www.NephroTube.com
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WHAT IS DIURETIC RESISTANCE?How to Tackle Congestion in Heart Failure?Renal handling of sodium and water.Adverse effects of major diuretics.There are two forms diuretic tolerance
Pathophysiology and mechanisms of loop diuretic resistance.Combination Diuretic Therapy. IV Diuretic .
Isolated ultrafiltration
Antibiotic dose modification is crucial on patients with CRRT with sepsis and MOF. This talk highlights the importance of achieving plasma therapeutic drug concentration in ICU patients to enhance their chances of survival while on CRRT
Alcoholic liver disease is a result of over-consuming alcohol that damages the liver, leading to a buildup of fats, inflammation, and scarring. It can be fatal.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Generalized edema can occur in a variety of disorders, including heart failure,
cirrhosis (where ascites is usually most prominent), and the nephrotic
syndrome
Significant edema is not always present in CKD, but CKD can produce resistance
to diuretic treatment.
Edematous patients generally respond to the combination of dietary Na
restriction, treatment of the underlying disease process, and diuretic
therapy, usually with a loop diuretic.
However, some patients are resistant to typical doses of diuretics.
3. Refractory Edema is defined as Edema that is refractory to
typically effective doses of loop diuretics.
4. I. CAUSES OF REFRACTORY EDEMA
1. Inadequate diuretic dose or frequency
2. Decreased oral diuretic absorption
3. Decreased loop diuretic tubular secretion
4. Enhanced tubular sodium reabsorption
5. High salt intake
6. Drugs that interfere with diuretic action
II. MANAGEMENT OF REFRACTORY EDEMA
1. Pretreatment evaluation
2. Stepwise approach to refractory edema
1. Intensification of oral loop diuretic therapy
2. Combination oral diuretic therapy
3. Intravenous loop diuretic bolus therapy
1. Continuous infusion option in patients who respond to bolus therapy
2. Patients unresponsive to intravenous diuretics
3. Benefit from a supine posture
Outline
5. CAUSES OF REFRACTORY EDEMA
1. Inadequate diuretic dose or frequency
2. Decreased intestinal absorption of oral diuretics
3. Decreased diuretic secretion into tubular fluid
4. Increased sodium reabsorption at sites in the nephron other than those inhibited
by the diuretic
5. Excess sodium intake
6. Concomitant administration of other classes of drugs that interfere with diuretic
action
6. 1.Inadequate diuretic dose or frequency
Diuretics do not produce natriuresis until a threshold rate of drug excretion is
attained .
If, for example, a patient does not respond to 40 mg of Furosemide, the dose
may not have exceeded this threshold.
Thus, the single dose should be increased to 60 or 80 mg, rather than giving the 40
mg dose twice a day.
Once a single effective dose has been determined, it is most commonly
administered multiple times per day at a frequency that is individualized to the
diuretic needs of the patient and the pharmacokinetic profile of the agent chosen.
7. Relation between the rate of furosemide excretion and the increase in sodium excretion in normals (solid
line) and patients with HF (dashed line).
A diuresis is not seen until a threshold rate of furosemide excretion is reached. Patients with HF show relative
resistance at a given rate of diuretic excretion due to increased sodium reabsorption in other nephron
segments.
8. 2.Decreased oral diuretic absorption
In patients with heart failure, decreased intestinal perfusion, reduced intestinal
motility, and perhaps also mucosal edema can reduce the rate of diuretic
absorption, and therefore reduce the rate of diuretic delivery into the tubular
lumen by as much as 50 to 70 %.
This reduced delivery of diuretic into the renal tubule may keep it below the
threshold .
Thus, patients with acute decompensated heart failure typically require initial
intravenous (IV) therapy.
9. 3.Decreased loop diuretic tubular secretion
• Loop diuretics must enter the tubular fluid in order to exert their diuretic effect .
• Loop diuretics are highly (≥95 %) protein bound.
• As a result, they primarily enter the tubular lumen by secretion by the proximal tubule, not
by glomerular filtration.
• Patients who do not respond to usual doses of loop diuretic therapy may be resistant
because of decreased diuretic secretion into the tubular lumen.
• This may result from decreased renal perfusion in patients with heart failure (due to the
reduced cardiac output), cirrhosis (due to renal vasoconstriction), and renal
impairment (due to competitive inhibition of tubular diuretic secretion by high
concentrations of organic anions that accumulate when the GFR is reduced).
10. 4.Enhanced tubular sodium reabsorption
• Some patients have partial or relatively complete resistance to a loop diuretic despite
adequate secretion of the diuretic into the tubular fluid (ie, despite having the same
rate of urinary diuretic excretion as normal controls) .
• This problem is often due to increased tubular sodium reabsorption by nephron
segments other than the loop of Henle .
• The decreased response to the action of a diuretic that results from increased sodium
reabsorption in other nephron segments has been called the diuretic braking
phenomenon
11. 5.High salt intake
• Maintenance of a high Na intake can prevent net sodium
loss and a reduction in extracellular fluid volume, even if
there is an appropriate natriuretic response to diuretics.
12. 6. Drugs that interfere with diuretic action
NSAIDs, which reduce the synthesis of vasodilator and natriuretic prostaglandins
and impair diuretic responsiveness
Thiazolidinediones, such as Rosiglitazone, increase renal salt retention as a result
of upregulation of the ENaC in the collecting ducts and also increase proximal
tubule sodium reabsorption
13. MANAGEMENT OF REFRACTORY EDEMA
•Pretreatment evaluation
•Stepwise approach to refractory edema
• Intensification of oral loop diuretic therapy
• Combination oral diuretic therapy
• Intravenous loop diuretic bolus therapy
• Continuous infusion option in patients who respond to bolus therapy
• Patients unresponsive to intravenous diuretics
•Benefit from a supine posture
14. Pretreatment Evaluation
Exclude excessive sodium intake – It is important to evaluate the patient's dietary
sodium intake and attempt to reduce it, if excessive. To estimate sodium intake, a 24-
hour urine should be collected.
Confirm that the patient requires a reduction in extracellular fluid volume –
While the mere presence of residual edema or pulmonary congestion (crackles or
breathlessness) is suggestive, the decision to further reduce the extracellular fluid
volume requires careful clinical judgement.
Before intensifying diuretic therapy, the following steps should be taken:
15. Stepwise approach to refractory edema
1- Intensification of oral loop diuretic therapy
Starting dose
(oral or intravenous)
Maximum effective dose
(higher individual doses or more frequent
dosing intervals are unlikely to produce
substantial additional diuresis)
Maximal recommended daily dose
(greater daily total doses are associated
with a risk for toxicity)
Furosemide Furosemide Furosemide
Heart failure 20 mg once or twice daily 80 mg 3 times daily 600 mg
Cirrhotic ascites 40 mg once or twice daily 40 mg 3 times daily 160 mg
Nephrotic syndrome 40 mg once or twice daily 120 mg 3 times daily 600 mg
Chronic kidney disease ‡ 200 mg 3 times daily 600 mg
Acute kidney injury 80 mg once or twice daily 500 mg once 600 mg
‡ Initial diuretic doses for patients with CKD depend on its stage .
16. Oral Furosemide Therapy
Starting dose
(oral or intravenous)
Maximum effective dose
(higher individual doses or more frequent
dosing intervals are unlikely to produce
substantial additional diuresis)
Maximal recommended daily dose
(greater daily total doses are associated
with a risk for toxicity)
Heart failure 20 mg once or twice daily 80 mg 3 times daily 600 mg
Cirrhotic ascites 40 mg once or twice daily 40 mg 3 times daily 160 mg
Nephrotic syndrome 40 mg once or twice daily 120 mg 3 times daily 600 mg
Chronic kidney disease ‡ 200 mg 3 times daily 600 mg
Acute kidney injury 80 mg once or twice daily 500 mg once 600 mg
‡ Initial diuretic doses for patients with CKD depend on its stage .
17. Stepwise approach to refractory edema
2. Combination oral diuretic therapy
When an adequate response to loop diuretics is not obtained, concurrent administration of a thiazide-
like (Metolazone) or thiazide-type (Hydrochlorothiazide) diuretic to block distal sodium chloride
reabsorption should be employed:
Without hypokalemia Metolazone (5 to 10 mg once daily initially, increased
to a maximum dose of 20 mg once daily) , although Hydrochlorothiazide (25 to 50 mg
twice daily initially, increased to a maximum dose of 200 mg per day) is likely just as
effective.
With hypokalemia Potassium-sparing diuretic first (eg, Amiloride or, particularly in
patients with heart failure, a mineralocorticoid receptor antagonist).
18. Stepwise approach to refractory edema
3- Intravenous loop diuretic bolus therapy
1. The initial dose of IV loop diuretic should be ~ 2 or 2.5 times the patient's total maintenance daily
oral dose
2. If there is little or no response to the initial dose, the dose should be doubled at two-hour
intervals, as needed, up to the maximum recommended doses rather than repeated at the
same dose.
3. Patients who do not have an adequate response to a maximal dose of one IV loop diuretic are
unlikely to respond to another loop diuretic since their mechanisms of action are similar.
19. Stepwise approach to refractory edema
3- Intravenous loop diuretic bolus therapy
4. Loop diuretics should not be administered IV as a rapid "push." Although there are no
data related to the optimal time over which a single IV dose of a loop diuretic should be
administered, the following approach seems reasonable; the doses are given
for Furosemide :
20 to 40 mg over five minutes
60 to 120 mg over 20 minutes
160 to 200 mg over 40 to 50 minutes (4 mg/min)
5. In patients who fail to respond to maximal IV bolus doses of a loop diuretic, a thiazide-like or
thiazide-type diuretic can be coadministered.
20. 3- Intravenous loop diuretic bolus therapy
a. Continuous infusion option in patients who respond to bolus therapy
1. In patients with refractory edema who respond to an IV bolus of a loop diuretic
but need ongoing diuresis Initiate a continuous loop diuretic infusion.
2. Continuous diuretic therapy may be less ototoxic than bolus therapy and
maintains a sustained effective rate of diuretic excretion.
21. 1. An IV loading dose of 40 to 80 mg of Furosemide is typically given over five minutes prior to
initiating the continuous infusion.
2. After the loading dose, the starting infusion rate with Furosemide varies with the level of kidney
function:
Acute Kidney Injury or CKD with eGFR less than 30 mL/min per 1.73 m2)
Initial Furosemide infusion rate of 20 mg per hour. If the diuresis is not sustained, a second bolus
is given followed by a higher infusion rate of 40 mg per hour.
eGFR greater than or equal to 30 mL/min per 1.73 m2 Initial Furosemide infusion rate of 5
mg per hour. If the diuresis is not sustained, a second bolus is given followed by a higher infusion
rate of 10 mg per hour. This rate may then be increased further to the maximum recommended
furosemide infusion rate of 40 mg per hour if response to lower doses is poor.
Continuous Infusion Protocol
22. 3- Intravenous loop diuretic bolus therapy
b. Patients unresponsive to intravenous diuretics
The excess fluid can be removed by ultrafiltration during renal
replacement therapy.
23. Benefit from a Supine posture
The supine position was associated with significantly higher mean creatinine
clearance (100 versus 66 mL/min) and diuretic response
The upright position was associated with significant increases in plasma
norepinephrine, renin, and aldosterone.
A value above 100 mmol in 24 hours (ie, 2.3 g of sodium) suggests that nonadherence with sodium restriction may be in part responsible for the resistance to diuretic therapy.
A value above 100 to 120 mmol in 24 hours also suggests that the diuretic response is adequate since true diuretic resistance is manifested by intense renal sodium retention.