Prescription of Lasix

 Q: Loop diuretics should always be given as rapid push? (select one)

A) True

B) False

Answer: B

Unfortunately, though loop diuretics are the most prescribed diuretics in ICU, there is less awareness that loop diuretics if given as a rapid push can be very distressing to the patient as can cause transient tinnitus. It can result in ototoxicity if given too fast. Orders should be written with instructions, like for furosemide (the most prescribed one) as 

•  20 to 40 mg over 5 minutes 
•  60 to 120 mg over 20 minutes 
• 160 to 200 mg over 40 to 50 minutes

#pharmacology

#nephrology

References:

1. Rybak LP. Pathophysiology of furosemide ototoxicity. J Otolaryngol. 1982;11(2):127-133. 

2. Kathleen A. Baldwin et al. Acute Sensorineural Hearing Loss: Furosemide Ototoxicity Revisited. Hospital Pharmacy. First Published December 1, 2008 https://doi.org/10.1310/hpj4312-982

3. Brater DC. Diuretic therapy. N Engl J Med 1998; 339:387.