Run the List Approach to Diuresis
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Nov 6, 2023 Dr. Leslie Chang and Dr. Joyce Zhou discuss determining volume status, guidelines for inpatient diuretic treatment, side effects of diuretics, and a case update on achieving effective diuresis.
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Determining Volume Status
- Assessing volume status involves history, physical exam (JVP is key), and labs (weight, NT-proBNP), but each has limitations.
- Consider orthopnea, paroxysmal nocturnal dyspnea, edema, and JVP for a comprehensive assessment.
Initial Diuretic Considerations
- Start with IV furosemide for hospitalized patients, guided by the "dose trial" in the New England Journal of Medicine.
- Double the IV furosemide dose until the patient starts urinating if the initial dose is ineffective.
Furosemide Dosing and Monitoring
- If the home dose is unknown, start with an IV furosemide dose 20-30 times the creatinine, especially in patients with lower GFR.
- Check the patient's urine output 1-2 hours after administering the diuretic and double the dose if needed.