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[q unit=”Pharmacology” topic=”Frusemide”] Potential indications for the use of Furosemide

[a] Cardiovascular indications
– Diuresis to decrease fluid balance, thought to be associated with improved mortality
– Preload reduction by volume reduction and venodilation
– Hyperkalemia and hypercalcemia

Toxicological and endocrine indications
– Diuresis to force urine output, eg prevent haemorrhagic cystitis 2^o to cyclophosphamide
– Urinary acidification, for toxicological purposes (to improve clearance of weak bases)

Endocrine and renal indications
– Urinary acidification in the context of RTA (Rastogi et al, 1985)

Other indications
– High altitude cerebral oedema
– High altitude pulmonary oedema

[q unit=”Pharmacology” topic=”Frusemide”] Proposed Benefits of Furosemide

[a] Cardiac failure
– Decreased preload and afterload decrease LV oxygen consumption and should improve symptoms from heart failure

Renal failure:
– Renal failure is typically associated with fluid overload due to oliguria, hyperkalemia and metabolic acidosis
– These derangements are also common indications for dialysis
– May mobilise fluid, increase elimination of potassium and promote alkalinisation of the extracellular fluid
==> Furosemide may reduce the need for dialysis

Electrolyte disturbances
– Electrolyte depletion caused by frusemide may be beneficial where those electrolytes are present in a dangerously high concentration, and where other clearance methods are not appropriate 

[q unit=”Pharmacology” topic=”Frusemide”] Evidence in support of Furosemide in ICU (excluding in renal failure)

[a] Cardiac failure
– 2013 AHA level 1 recommendation for loop diuretics, DOSE trial 2011 showed some improvement in secondary outcomes and symptoms when furosemide increased by 2.5x

Cardiorenal syndrome
– Ronco et al 2008 showed similar benefits as in heart failure

To decrease fluid balance
– Shen et al 2019: decreased mortality in shocked patients

Portal hypertension Mx
– Garcia-Pagan et al 1999: furosemide plus other agents better than furosemide alone

Acute hypercalcaemia
– Suki et al (1970): some success with 100mg Q2h

Transfusion-related circulatory overload (TACO)
– Cochrane review 2015 – no benefit here 

[q unit=”Pharmacology” topic=”Frusemide”] Evidence in support of Furosemide in ICU (IN renal failure)

[a] Does NOT prevent acute renal failure perioperatively
– Zacharias et al 2013

Does NOT reduce mortality in established renal  failure
– Bove et al 2018

Does NOT prevent progression ot dialysis in acute renal failure
– SPARK study (Bagshaw et al 2017)

Does NOT improve recovery from anuric renal failure
– van der Voort et al 2009

MAY decrease mortality when used to PREVENT renal failure
– Bove et al 2018: trend toward benefit with intermittent furosemide
– Joannides et al 2017: ineffective as solo agents to prevent AKI from nephrotoxic insults 

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