In an aging population, decompensated heart failure accounts for a significant number of hospital admissions. The standard management for edema and congestion associated with heart failure is loop diuretic therapy. Traditionally, bolus-dosed furosemide has been used to manage the edema and congestion associated with heart failure. However, diuretic resistance can occur with bolus dosing, resulting in inadequate diuresis and further hemodynamic instability. Based on current literature, furosemide given by continuous infusion may now be the preferred agent and route for diuretic refractory heart failure. This article reviews the literature that compares bolus versus continuous infusion loop diuretics in adult heart failure.
GargR., PackerM., PittB.Heart failure in the 1990's: Evolution of a major public health problem in cardiovascular medicine. J Am Coll Cardiol.1993; 3A–5A.
2.
Hurst's The Heart. 9th ed. 750–52.
3.
OpieL.H.Drugs for the Heart.3rd ed.W. B. Saunders; 1992, 74–9.
4.
DormansT.P.J., GerlagP.G.G., RusselF.G.M.Combination diuretic therapy in severe congestive heart failure. Drugs.1998; 55: 165–72.
5.
Van MeyelJ.M., SmitsP., RusselF.G.M.Diuretic efficiency of furosemide during continuous administration versus bolus injection in healthy volunteers. Clin Pharmacol Ther.1992; 51: 440–4.
6.
KaojarernS., DayB., BraterD.C.The time course delivery of furosemide into urine: An independent determinant of overall response. Kidney Inter.1982; 22: 69–74.
7.
DormansT., van MeyelJ., GerlagP.Diuretic efficacy of high dose furosemide in severe heart failure: Bolus injection versus continuous infusion. J Am Coll Cardiol.1996; 28: 376–82.
8.
LahavM., RegevA., Ra'ananiP.Intermittent administration of furosemide versus continuous infusion preceded by a loading dose for congestive heart failure. Chest.1992; 102: 725–31.
9.
Van MeyelJ., SmitsP., DormansT.Continuous infusion of furosemide in the treatment of patients with congestive heart failure and diuretic resistance. J Inter Med.1994; 235: 329–34.
10.
KramerW.G., SmithW.B., FergusonJ.Pharmacodynamics of torsemide administered as an intravenous injection and as a continuous infusion to patients with congestive heart failure. J Clin Pharmacol.1996; 36: 265–70.
11.
RudyD.W., VoelkerJr, GreeneP.K.Loop diuretics for chronic renal insufficiency: A continuous infusion is more efficacious than bolus therapy. Ann Intern Med.1991; 115: 360–6.
12.
GerlagP., van MeijelK.High dose furosemide in the treatment of refractory congestive heart failure. Arch Intern Med.1989; 148: 286–91.
13.
BraterD.C., DayB., BurdetteA.Bumetanide and furosemide in heart failure. Kidney Inter.1984; 26: 183–9.
14.
HammarlundM.M., OdlindB.O., PaalzowL.K.Acute tolerance to furosemide diuresis in humans: Pharmacokinetic-pharmacodynamic modeling. J Pharmacol Exp Ther.1985; 233: 447–53.
15.
BraterD.C., SeiwelR., AndersonS.Absorption and distribution of furosemide in congestive heart failure. Kidney Intern.1982; 22: 171–6.
16.
VaskoM.R., Brown-CartwrightD., KnochelJ.P.Furosemide absorption altered in decompensated congestive heart failure. Ann Inter Med.1985; 102: 314–8.
17.
BraterD.C.Disposition and response to bumetanide and furosemide. Am J Cardiol.1986; 22: 171–5.
18.
LoonN.R., WilcoxC.S., UnwinR.J.Mechanism of impaired natiuretic response to furosemide during prolonged therapy. Kidney Inter.1989; 36: 682–9.
19.
EllisonD.H., VelazquezH., WrightF.S.Adaptation of the distal convoluted tubule of the rat: Structural and functional effects of dietary salt intake and chronic diuretic infusion. J Clin Invest.1989; 83: 113–26.
20.
SchrierR.W., AbrahamW.T.Hormones and hemodynamics in heart failure. New Eng J Med.1999; 341: 577–85.
21.
FrancisG.S., BenedictC., DphilComparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. Circulation.1990; 82: 1724–9.
22.
The SOLVD investigators.Effects of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure. New Eng J Med.1991; 325: 293–302.
23.
PittB., ZannadF., RemmeW.J.The effects of spironolactone on morbidity and mortality in patients with severe heart failure. New Eng J Med.1999; 341: 709–16.
24.
SchrierR.W.Pathogenesis of sodium and water retention in high output and low output cardiac heart failure, nephrotic syndrome, cirrhosis and pregnancy. New Eng J Med.1989; 319: 1065–72 (erratum, New Eng J Med. 1989; 320: 676.
25.
AllM.J., SanoskiC.A.Optimizing inhibition of aldosterone: Use of spironolactone in chronic heart failure. Formulary.1999; 34: 752–63.
26.
TrelawnyJ.M.Can we improve diuretic response in heart failure?Brit J Hosp Med.1996; 55: 616–9.
27.
CodyR.J., KuboS.H., PickworthK.K.Diuretic treatment for the sodium retention of congestive heart failure. Arch Intern Med.1994; 154: 1905–14.
28.
LawsonD.A., GrayJ.M., HenryD.A.Continuous infusion furosemide in refractory edema. Br Med J.1978; 2: 476.
29.
HowardP., DunnM.Severe musculoskeletal symptoms during continuous infusion of bumetanide. Chest.1997; 111: 359–64.
