Q: Continuous infusion and bolus intravenous loop diuretic overall carries same efficacy in heart failure (CHF) patients. Beside, less chances of ototoxicity, what other advantage continuous infusion of loop diuretic may have over IV bolus in CHF patients? 


Answer: It helps in maintaining sodium level

Continuous intravenous infusion maintains an effective rate of drug excretion, and  inhibits sodium chloride reabsorption in the loop of Henle. IV bolus doses of loop diuretics, as expected are associated with higher and then lower rate of drug excretion, causing unreliable maintenance of sodium chloride hemostasis.


References: 

 1. Rudy DW, Voelker JR, Greene PK, et al. Ann Intern Med 1991; 115:360. 

2.  Brater DC, Day B, Burdette A, et al. Kidney Int 1984; 26:183