Appropriate diuretic dosing: Closed loop communication

A Diuretic Protocol Increases Volume Removal and Reduces Readmissions Among Hospitalized Patients With Acute Decompensated Heart Failure

“…Second, the patient's urinary output in response to a given dose must be assessed at appropriate time intervals to determine subsequent diuretic dosing. Dosing intervals need to be based on pharmacokinetic knowledge of the various loop diuretics instead of arbitrary protocols and empiric physician decisions …”

“…A patient's response to a diuretic dose is variable and is dependent on several factors including serum albumin level, renal and liver function, and diuretic resistance . Therefore, diuretic dosing should be individualized based on response …”

“…Dosing intervals need to be based on pharmacokinetic knowledge of the various loop diuretics instead of arbitrary protocols and empiric physician decisions. 9 Furosemide and bumetanide have similar elimination half-lives of 1 to 2 hours and peak intravenous (IV) effects at 30 minutes. 10,11 IV torsemide has a longer half-life of 3 to 4 hours.…”

“…10 Therefore, diuretic dosing should be individualized based on response. 9 Current guidelines published by the European Society of Cardiology, the American Heart Association (AHA), and the American College of Cardiology (ACC) do not include details about the optimal approach to using loop diuretics in patients with ADHF. 12,13 To optimize treatment, we designed a loop diuretic protocol for patients admitted with ADHF that included frequent assessment and follow-up of dose response with appropriate titration.…”