Furosemide is a diuretic which is used to control high blood pressure and oedema. It is the most frequently used diuretic in critically ill patients. It exerts its action by selectively blocking the Na+/K+/2Cl− co-transporter in the luminal membrane of the thick ascending limb of the loop of Henle. There are several FDA warnings including Liver function warning, low blood pressure warning, low potassium levels warning, low thyroid levels warning.
In addition to this Diuretic resistance is not uncommon in patients receiving prolonged therapy with loop diuretics. Also, there are concerns that diuretic use may be associated with harmful effects, including acute kidney injury (AKI) leading to uncertainty among clinicians about when and how to use frusemide safely and effectively in critically ill patients with and without AKI.
In an editorial appearing in Journal, Intensive Care Medicine authors Dr Michael Joannidis and colleagues have addressed ten common myths about frusemide and its application in critically ill patients in a comprehensive manner.
Ten Common myths are-
- Myth #1-Frusemide causes AKI-No, it does not.
- Myth #2-Frusemide and fluids together can prevent AKI in high-risk patients.-Probably not.
- Myth #3-Frusemide is contraindicated in AKI.-No, it is not.
- Myth #4-Frusemide can kick-start kidney function.-No, this is not the case.
- Myth #5-Frusemide works better if given together with albumin.-It depends.
- Myth #6-Frusemide infusion is more effective than frusemide boluses.-No, it is not.
- Myth #7-Frusemide can prevent renal replacement therapy (RRT).-No, it can’t.
- Myth #8-Frusemide helps to wean anuric patients from RRT.-No, it does not.
- Myth #9-Frusemide-induced diuresis after AKI implies full renal recovery.-No, it does not.
- Myth #10-Frusemide should be stopped if serum creatinine is increasing, indicating worsening renal function.-No, not necessarily.
The Food and Drug Administration (FDA) has approved the use of furosemide in treatment of conditions with volume overload and oedema secondary to congestive heart failure exacerbation, liver failure, or renal failure including the nephrotic syndrome. Furosemide use is contraindicated in patients with documented allergy to furosemide and patients with anuria. Lately, furosemide has been proposed to be used through subcutaneous route for domiciliary treatment of heart failure. It is a wonder drug but the doubts about its use may crop up from time to time and they need to be addressed expeditiously.
For further reference log on to : https://doi.org/10.1007/s00134-018-5502-4