A 55-year-old man on ICU has acute decompensated heart failure with pulmonary oedema. He is receiving IV frusemide 80 mg boluses without adequate diur...

Question

A 55-year-old man on ICU has acute decompensated heart failure with pulmonary oedema. He is receiving IV frusemide 80 mg boluses without adequate diuretic response (urine output

Accepted Answer

Commence a continuous IV frusemide infusion (e.g. 10-40 mg/hr) and consider adding a thiazide diuretic (metolazone) for sequential nephron blockade

Answer

Switch to oral frusemide

Answer

Stop frusemide and commence IV mannitol

Answer

Administer IV albumin to improve diuretic efficacy

Answer

Increase IV frusemide bolus to 500 mg

uk-fficm MCQ (SBA): Diuretic Resistance

A 55-year-old man on ICU has acute decompensated heart failure with pulmonary oedema. He is receiving IV frusemide 80 mg boluses without adequate diuretic response (urine output <30 mL/hr). Serum creatinine is 200 µmol/L. What is the most appropriate next step to improve diuretic response?