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PubMed2004

Use of furosemide and hearing loss in neonatal intensive care survivors.

Hearing loss is a significant morbidity in survivors of the neonatal intensive care unit (NICU). The overall prevalence of hearing loss in neonates is 0.93 per 1000 live births, whereas in neonates weighing less than 2000 g, it is as high as 15.5 per 1000 live births. The increased incidence of hearing loss in NICU graduates has been attributed to their underlying disease process as well as exposure to ototoxic drugs including furosemide. A retrospective chart review of all neonatal intensive care survivors was done to evaluate the potential effect of furosemide on hearing loss. From July 2000 to January 2002, there were 57 neonates who received and 207 neonates who did not receive furosemide. The incidence of abnormal hearing screen was 15.5% in the furosemide group and 15.9% in the nonfurosemide group ( p = 0.9). Although the incidence of hearing loss is significantly higher in NICU graduates in comparison with the general neonatal population, it does not seem to be directly related to the use of furosemide.

Auditory Threshold↗
PubMed1987

Cumulative increase in serum furosemide concentration following repeated doses in the newborn.

In order to test whether repeat doses of the diuretic furosemide result in plasma accumulation of this drug, eight newborns (mean birthweight, 1252 gm; mean gestational age, 27.5 weeks; mean postnatal age, 44.7 days; and normal renal function) were each given a 1-mg/kg iv bolus every 12 hr for four doses and maintained normally hydrated throughout the study period. Serum furosemide peak concentrations (1 hr after administration) were measured in eight newborns, and trough levels in four newborns, by HPLC. The mean 1-hr serum furosemide level increased with repeated doses of the drug, from 3.18 +/- 0.52 to 7.95 +/- 2.36 mg/liter (mean +/- SE) (p less than .05). In contrast, the mean serum trough concentration of furosemide remained at a plateau following the first dose (1.8 +/- 0.82 to 1.98 +/- 1.81 mg/liter), suggesting attainment of a steady state. This accumulation of furosemide following repeated doses of this diuretic, therefore, reflects the decreased plasma clearance of the drug, possibly due to contraction of its volume of distribution.

Chromatography, High Pressure Liquid↗
PubMed1986

Furosemide lowers intracranial pressure by inhibiting CSF production.

Furosemide administration effectively lowers intracranial pressure in newborn preterm and term rabbit pups. This effect may be due to the diuretic action of the drug, its ability to inhibit cerebrospinal fluid production or to a combination of both. To test these possibilities newborn rabbits were either injected with furosemide and left unmolested for 6 hours, or anaesthetized and subjected to ventriculocisternal perfusions. During the 6 hour postnatal period the decrease in body weight was 8 times greater in furosemide than in saline treated pups. However, no difference was noted between the average brain weights of these two groups. Secondary effects of the diuretic were noted in blood (12.5% increase in the haematocrit over control value) and in muscle in which tissue water content and NA+ concentration were decreased while K+ concentration was increased. The fact that these parameters remained unchanged in brain suggests that the lowering of intracranial pressure was not attributable to the secondary effects of the diuretic agent. However, the marked reduction in cerebrospinal production noted following furosemide administration indicates that in newborn rabbits this may represent the primary mechanism by which furosemide lowers intracranial pressure.

Animals↗
PubMed1989

Protective effect of inhaled furosemide on allergen-induced early and late asthmatic reactions.

The movement of ions and water across the membranes of bronchial cells is part of the control of the bronchial obstructive response to physical stimuli. In a double-blind, randomized, crossover study, we compared the effect of an aerosol of the loop diuretic furosemide with that of a placebo on the early (within 60 minutes) and late (4 to 12 hours) asthmatic responses to a specific inhaled allergen. We studied 11 subjects with mild allergic asthma, who had both early and late asthmatic responses to a specific inhaled allergen in a preliminary challenge. After placebo administration, the maximal changes (mean +/- SE) from base line in the forced expiratory volume in one second (FEV1) and specific airway resistance were, respectively, a decrease of 35 +/- 4 percent and an increase of 288 +/- 56 percent between 0 and 60 minutes after inhalation of the allergen (early response) and a decrease of 35 +/- 5 percent and an increase of 301 +/- 40 percent between 4 and 12 hours (late response). After furosemide administration (4 ml; 10 mg per milliliter), the early response to inhaled allergen was markedly attenuated in all the subjects, and the late response in all but one. The maximal changes in the FEV1 and specific airway resistance were, respectively, a decrease of 11 +/- 2 percent and an increase of 61 +/- 2 percent between 0 and 60 minutes and a decrease of 20 +/- 4 percent and an increase of 178 +/- 25 percent between 4 and 12 hours (P less than 0.05 for all comparisons). No significant differences were seen in the bronchoconstrictor response to inhaled methacholine after furosemide or placebo administration. We conclude that a furosemide-sensitive mechanism in the airways is involved in the pathogenesis of the reactions of patients with allergic asthma. Whether inhaled furosemide might be useful in the treatment of allergic asthma is uncertain and will require further study.

Adolescent↗
PubMed1994

Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents.

BACKGROUND: Injections of radiocontrast agents are a frequent cause of acute decreases in renal function, occurring most often in patients with chronic renal insufficiency and diabetes mellitus. METHODS: We prospectively studied 78 patients with chronic renal insufficiency (mean [+/- SD] serum creatinine concentration, 2.1 +/- 0.6 mg per deciliter [186 +/- 53 mumol per liter]) who underwent cardiac angiography. The patients were randomly assigned to receive 0.45 percent saline alone for 12 hours before and 12 hours after angiography, saline plus mannitol, or saline plus furosemide. The mannitol and furosemide were given just before angiography. Serum creatinine was measured before and for 48 hours after angiography, and urine was collected for 24 hours after angiography. An acute radiocontrast-induced decrease in renal function was defined as an increase in the base-line serum creatinine concentration of at least 0.5 mg per deciliter (44 mumol per liter) within 48 hours after the injection of radiocontrast agents. RESULTS: Twenty of the 78 patients (26 percent) had an increase in the serum creatinine concentration of at least 0.5 mg per deciliter after angiography. Among the 28 patients in the saline group, 3 (11 percent) had such an increase in serum creatinine, as compared with 7 of 25 in the mannitol group (28 percent) and 10 of 25 in the furosemide group (40 percent) (P = 0.05). The mean increase in serum creatinine 48 hours after angiography was significantly greater in the furosemide group (P = 0.01) than in the saline group. CONCLUSIONS: In patients with chronic renal insufficiency who are undergoing cardiac angiography, hydration with 0.45 percent saline provides better protection against acute decreases in renal function induced by radiocontrast agents than does hydration with 0.45 percent saline plus mannitol or furosemide.

Aged↗
PubMed2002

Benefits of prophylactic continuous infusion of furosemide after the maze procedure for atrial fibrillation.

OBJECTIVES: One of the most significant complications seen after the maze procedure for atrial fibrillation is excessive fluid retention, with subsequent pulmonary complications. To address this problem we recently started treating all patients prophylactically with a continuous infusion of furosemide starting immediately after the operation. METHODS: Seventy-five consecutive patients with statistically similar demographic characteristics were divided into two groups. In the continuous infusion group (n = 36) furosemide was given intravenously as a continuous infusion at a dose of 2 to 15 mg/h for the first 48 hours after the operation, and in the bolus dose group (n = 39) furosemide was administered in bolus doses (50-100 mg) to maintain a targeted daily urinary output of 25 to 50 mL/kg. Hemodynamic data, urinary output, fluid balance, daily weights, and pulmonary complications were recorded during the first 48 hours after the operation. RESULTS: The mean postoperative urinary output was higher, the total furosemide dose was lower, and the pulmonary complications were fewer in the continuous infusion group than in the bolus dose group. Three patients in the bolus dose group were reintubated after the operation, whereas none in the continuous infusion group were reintubated. Supplemental oxygen requirements were greater in the bolus dose group (7 vs 4 patients, P <.05). In the bolus dose group, 4 patients (10%) required thoracentesis and 3 patients (8%) required chest tube insertions for postoperative pleural effusions, in contrast with 1 patient (3%) each in the continuous infusion group (P <.05). CONCLUSION: Despite a smaller total dose relative to bolus infusion, prophylactic continuous furosemide infusion decreased the adverse pulmonary complications associated with excessive fluid retention in patients undergoing the maze procedure for atrial fibrillation.

Atrial Fibrillation↗
PubMed1988

On the mechanism of acute tolerance to furosemide diuresis.

The renal response to continuous furosemide infusion (8 mg/h) and subsequent ECV changes was studied in 8 healthy volunteers. Furosemide increased urine flow from a basal flow of 4.3 ml/min to a maximum of 15.4 ml/min. During dehydration (-1.8 kg) the diuresis decreased to 8.4 ml/min. The sodium, chloride and potassium excretion likewise decreased. This reduction in diuretic effect (acute tolerance) was accompanied by significantly increased plasma levels of norepinephrine (1.38 to 2.14 nmol/l), PRA (0.52 to 1.13 ng/ml/h) and aldosterone (0.29 to 0.45 nmol/l). After rehydration the urine flow increased to 23.1 ml/min. The changes in diuretic response from initial effect to the dehydrated state and after rehydration were mainly a consequence of changed renal sensitivity to furosemide (urinary excretion of 21 to 14 to 35 mumol Na+ per microgram furosemide excreted). It is proposed that activation of the sympathetic nervous system and/or the renin-angiotensin-aldosterone system may play a role in mediating the acute tolerance to furosemide diuresis. The relative importance of each remains to be clarified.

Adult↗
PubMed1989

Lack of a modifying effect by the diuretic drug furosemide on the development of neoplastic lesions in rat two-stage urinary bladder carcinogenesis.

The effect of the diuretic drug furosemide on two-stage urinary bladder carcinogenesis in F344 rats initiated by N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) was investigated with regard to possible promoting activity. BBN was administered at 2 doses, 0.01 or 0.05%, in drinking water for 4 wk, and thereafter furosemide was given by gavage 3 times weekly for 32 wk, 250 mg/kg body weight. Furosemide ingestion induced diuresis with an alkaline, hypotonic urine. No significant difference with regard to incidences of bladder lesions were apparent between furosemide and control groups. The present investigation indicated that neither furosemide nor its related polyuria acted as a promoter in two-stage urinary bladder carcinogenesis.

Animals↗
PubMed2002

Comparison of the efficacy of continuous furosemide and low-dose dopamine infusion in preeclampsia/eclampsia-related oliguria in the immediate postpartum period.

AIM: To compare the efficacy of furosemide infusion with that of low-dose dopamine infusion in improving urine output and subsequent renal function in preeclamptic/eclamptic patients with oliguria in the immediate postpartum period. DESIGN: Prospective randomised single blind clinical trial. SETTING: Obstetric High Care Unit of King Edward VIII Hospital, a large referral tertiary hospital. METHOD: Eighty postpartum patients with severe preeclampsia/eclampsia with oliguria were enrolled. Hypovolaemia was corrected under central venous pressure (CVP) monitoring and urine output monitored for 4 hr. Patients who remained oliguric were randomly assigned to a continuous infusion of low-dose dopamine (3 microg/kg/min), or furosemide 5 mg/hr infusion, for 12 hr. In patients with no response after 12 hr, the drugs were switched and continued for a further 12 hr. A subgroup of patients who responded 4 hr after correction of hypovolaemia was observed for 12 hr. The primary outcome measured involved the comparison in urine output between the different drug regimes and the number of patients requiring haemodialysis. Secondary outcome measures involved assessment of serum urea and creatinine values in the two treatment groups. RESULTS: Of the 80 patients enrolled, 20 improved their urine outputs within the 4-hr observation period. Sixty patients were randomised to furosemide or low-dose dopamine infusion. There was no statistical significant difference in the mean hourly urine output, rate of change in urine output over time and the mean urea or creatinine levels between the treatment groups. Ten percent of patients that failed on furosemide primarily, and 8.5% of patients that failed on initial low-dose dopamine, received haemodialysis. The difference in demographic and clinic data between these groups was not statistically significant. CONCLUSION: Administration of continuous infusion of furosemide showed comparable efficacy to low-dose dopamine infusion in ameliorating oliguria in severe preeclampsia/eclampsia post delivery; there was no difference in the percentage of patients that required haemodialysis in either group.

Adult↗
PubMed1993

Increased prevalence of cardiovascular complications in women with furosemide resistant essential hypertension.

Patients with essential hypertension (n = 2969) who had not been taking any blood pressure medication for longer than 1 week were classified as furosemide-sensitive (FS) if their diastolic BP after furosemide fell > or = 10% and furosemide-resistant (FR) if it fell less than that. The FS group was significantly (P < or = .05) older, and had higher blood pressure than the FR group. In patients over age 50, the prevalence of cardiovascular complications (myocardial infarction, stroke, angina, congestive heart failure, and intermittent claudication) in the FR group (12.3%) was significantly (P = .0039) more than in the FS group for all patients, and especially for women (P = .0053). This was not explained by plasma renin activity, plasma norepinephrine, obesity index, cholesterol, blood sugar, or smoking history, and was associated in the FR group with a lower BP. This study characterizes the furosemide response of BP in hypertensive subjects and demonstrates an increased prevalence of cardiovascular complications in women over age 50 in the furosemide resistant group.

Adult↗
PubMed2004

A randomized trial of furosemide vs hydrochlorothiazide in patients with chronic renal failure and hypertension.

BACKGROUND: Loop diuretics are the drugs of choice for the treatment of hypertension in chronic renal failure patients. However, the adaptive changes in the distal nephron and the short half-life of these drugs may decrease their long-term efficacy. Thiazides are not believed to be efficient in advanced renal failure, but this is debated. METHODS: We compared the efficacy of long-acting furosemide (60 mg/day) and hydrochlorothiazide (25 mg/day) in a double-blind, randomized crossover trial in seven patients with severe renal failure and hypertension (seven men, 54+/-10 years old). The primary end-points were sodium and chloride fractional excretions after 1 month of each diuretic and then after their combination. During the trial, other treatments and the diet were controlled. RESULTS: A trend towards an increase in the fractional excretion of sodium and of chloride was observed with furosemide, but the difference did not reach the level of statistical significance (P = NS). Hydrochlorothiazide significantly increased fractional excretion of sodium and chloride from 3.7+/-0.9 to 5.5+/-0.3 and from 3.9+/-0.19 to 6.5+/-0.3, respectively (P<0.05). The combination of the two diuretics had no additional effect on the increase in sodium and chloride fractional excretion. Furosemide, hydrochlorothiazide and the combination of the two diuretics decreased mean arterial blood pressure by the same extent from 112 to 97, 99 and 97 mmHg, respectively (P<0.05). CONCLUSIONS: Hydrochlorothiazide increased the fractional excretion of sodium and chloride more than furosemide did in hypertensive severe renal failure patients. Mean arterial blood pressure decreased by the same amount with both diuretics. Combining furosemide and hydrochlorothiazide did not increase the efficacy of hydrochlorothiazide.

Adult↗
PubMed1992

Effect of cicletanine on reperfusion-induced arrhythmias and myocardial ion contents: a comparison with furosemide.

We studied the effects of cicletanine, a furopyridine antihypertensive drug, and furosemide, a loop diuretic, on ventricular arrhythmias, such as sustained ventricular fibrillation (VF) and ventricular tachycardia (VT), and myocardial ion content in Langendorff rat hearts subjected to 30 min global ischaemia then 10 min reperfusion. Myocardial Na+, K+, Ca2+ and Mg2+ concentrations were measured by washout technique and atomic absorption spectrophotometry before and after ischaemia and reperfusion. Drugs were either perfused (acute treatment) or orally gavaged daily to the rats for 14 days before isolation of their hearts (chronic treatment). Under in vitro conditions 10(-5), 3 x 10(-5), 10(-4) or 3 x 10(-4) M of cicletanine reduced the incidence of sustained VF and VT from the control values of 91% and 100% to 83% and 100%, 50% (P less than 0.05) and 67%, 33% (P less than 0.01) and 50% (P less than 0.05), 25% (P less than 0.01) and 41% (P less than 0.05), respectively. Chronic treatment with 3, 10, 30 or 100 mg.kg-1.day-1 of cicletanine also resulted in a dose-dependent anti-arrhythmic effect. Neither acute (10(-5), 3 x 10(-5) and 10(-4) M) nor chronic furosemide treatment (3, 10 and 30 mg.kg-1.day-1) influenced the incidence of arrhythmias. Acute treatment with cicletanine or furosemide did not change myocardial ion concentrations, in non-ischaemic hearts, while chronic treatment with 30 mg.kg-1.day-1 furosemide significantly reduced myocardial Na+, K+ and Mg2+ content and increased Ca2+ concentration. Both acute and chronic cicletanine treatments attenuated ischaemia/reperfusion-induced myocardial Na+ and Ca2+ gains and K+ loss, while furosemide did not.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Haemodynamic effects of high or low doses of furosemide in acute myocardial infarction.

The haemodynamic effects of high or low doses of furosemide used to prevent overt left heart failure (LHF) in acute myocardial infarction (AMI) were studied. Fifteen consecutive AMI patients without overt LHF and with a cardiac index (CI) of 2.6 +/- 0.5 l min-1 m-2, a right atrial mean pressure (RAMP) of 7 +/- 3 mmHg and a pulmonary arterial diastolic pressure (PADP) of 14 +/- 4 mmHg were investigated during 24 h. A high dose group (HDG) received 40 mg furosemide t.i.d. and a low dose group (LDG) 20 mg once daily. Following the first 40 mg of furosemide (HDG), the stroke volume index (SVI), CI, RAMP and PADP decreased. The heart rate and systemic vascular resistance index (SVRI) increased. Following the first 20 mg of furosemide (LDG), the only significant change was a decrease in PADP. After 24 h, the heart rate in the HDG was further increased; the SVI, RAMP and PADP were further reduced, whereas CI was similar to that before. In the LDG, the heart rate, SVI and CI remained unchanged. All pressures tended to decline and the SVRI was lower than in the HDG. Thus, repeated injections of 40 mg of furosemide induced a sustained preload reduction in AMI patients without overt LHF, but this was associated with potentially disadvantageous haemodynamic findings.

Aged↗
PubMed1989

Effect of high calcium and phosphorus intake on mineral retention in very low birth weight infants chronically treated with furosemide.

The treatment of premature infants with the diuretic furosemide appears to be a contributory factor in the development of metabolic bone disease presumably because of furosemide-induced hypercalciuria. In this study, we measured calcium and phosphorus balance in furosemide-treated very low birth weight infants (VLBW) infants with bronchopulmonary dysplasia (BPD) who were fed a specialized premature formula containing increased amounts of calcium and phosphorus. Furosemide-treated infants received 166 +/- 37 mg/kg/day and retained 80 +/- 34 mg/kg/day of calcium, and 87 +/- 19 mg/kg/day and retained 52 +/- 14 mg/kg/day of phosphorus. The amounts retained were approximately 65% of the calcium and 72% of the phosphorus requirements for in utero mineral accretion. Compared to a group of similarly fed VLBW infants without BPD and not treated with the diuretic, the furosemide-treated infants excreted a larger percent of the calcium intake in the urine but had similar total urinary calcium and phosphorus losses (mg/kg/day) and serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) levels. From the latter two findings, we suggest that the extra mineral content of the formula may have promoted bone mineralization and prevented the occurrence of secondary hyperparathyroidism.

Calcium↗
PubMed1987

Routine methods in toxicology and therapeutic drug monitoring by high performance liquid chromatography: III. A rapid microscale method for determination of furosemide in plasma and urine.

A highly specific, sensitive, and rapid microscale method is described for determining furosemide levels in plasma and urine. Monitoring furosemide levels has been recommended in patients with impaired renal function and in premature infants since furosemide has been known to cause ototoxicity. The method described here is simple, easy to run, takes only 7 min per sample, and can be set up for routine monitoring of furosemide by clinical laboratories. The method uses ion-pairing high performance liquid chromatography and detection of furosemide by fluorescence, which gives excellent separation and high sensitivity with minimal sample preparation. The method requires only 25 microliters of plasma or urine and, thus, is suitable for use in newborn intensive care units.

Chromatography, High Pressure Liquid↗
PubMed2005

Sweet syndrome associated with furosemide.

This case report describes a case of Sweet syndrome (SS) related to use of furosemide in a 46-year-old female who was admitted for treatment of congestive heart failure. Three days after administration of furosemide, the patient had a fever and a skin eruption appeared on her wrists, forearms, and legs. Biopsy of the skin lesion was consistent with SS. Infection was thought to be unlikely because of negative blood cultures, echocardiography, and other imaging studies. Careful review of her medications revealed that the patient received furosemide before the appearance of the skin eruption and fever. After discontinuation of furosemide, the patient's skin lesion and fever resolved. A MEDLINE search from June 1966 to May 2004 revealed only one reference documenting the association of SS with furosemide administration. Patients who have development of SS without an obvious cause should have their medication list closely reviewed.

Diuretics↗
PubMed1985

Abnormal renal sodium excretion in the nephrotic syndrome after furosemide: relation to glomerular filtration rate.

The effect of 40 mg furosemide intravenously on sodium excretion, the renin-aldosterone system and arginine vasopressin (AVP) was studied in 14 patients with the nephrotic syndrome and in 13 control subjects. Creatinine clearance (Ccr) was reduced in all patients but four. Before furosemide, AVP, but not angiotensin II (AII) or aldosterone (Aldo), was increased in the nephrotic patients. After furosemide, sodium excretion (NaE) increased less and changes in AVP, AII and Aldo were blunted in the patients. Ccr and NaE were positively correlated in the nephrotic syndrome. The reduced sodium response after furosemide in the nephrotic syndrome seems to be closely correlated to a reduced glomerular filtration rate but not to an increased activity of the renin-angiotensin-aldosterone system. The reduced response of AVP, AII and Aldo after furosemide is consistent with a lower degree of volume depletion in nephrotic patients.

Adult↗
PubMed2005

Serum concentration of potassium in chronic heart failure patients administered spironolactone plus furosemide and either enalapril maleate, losartan potassium or candesartan cilexetil.

OBJECTIVE: To retrospectively investigate elevation of serum potassium when spironolactone (25 or 50 mg/day) and furosemide were administered concomitantly with an angiotensin II converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) to patients with chronic heart failure for 12 months and occurrence of hyperkalemia and hypokalemia because of concomitant administration of spironolactone plus an ACE-I or ARB and furosemide. METHODS: Patients with chronic heart failure, who visited departments of cardiovascular internal medicine and cardiovascular surgery at the National Hospital Organization Osaka Medical Center, were enrolled for this study. Serum potassium, blood urea nitrogen (BUN), serum creatinine, uric acid, and serum sodium were determined in every patient at the time of start of treatment and at 3 and 12 months of treatment. Data from patients in Groups A (25 mg/day spironolactone + 40 mg/day furosemide + an ACE-I or ARB) and B (50 mg/day spironolactone + 40 mg/day furosemide + an ACE-I or ARB) were analysed for differences with respect to the ACE-I and ARB used. RESULTS: When 50 mg/day spironolactone plus 5 mg/day enalapril maleate (enalapril) or 50 mg/day losartan potassium (losartan) or 8 mg/day candesartan cilexetil (candesartan) plus 40 mg/day furosemide were concomitantly used, the mean value of serum potassium was significantly elevated only in the group treated with 50 mg/day spironolactone regardless of the concomitant drug. The number of patients with hyperkalemia (>5.5 mEq/L) at 12 months of treatment was 12 (8.8%), while the number of patients with hypokalemia (<or=3.5 mEq/L) was 7 (5.1%). However, the occurrence of hyperkalemia was almost the same regardless of the dose of spironolactone or the ACE-I or ARB concomitantly administered. Therefore, if enalapril, losartan, or candesartan is concomitantly used, it is necessary to monitor the serum concentration of potassium, even if spironolactone is administered at a dose of 25 mg/day. CONCLUSION: The occurrence of hyperkalemia in patients administered spironolactone is influenced by the dose, but when it is used concomitantly with enalapril, losartan or candesartan, the occurrence of hyperkalemia exceeding 5.5 mEq/L may increase even if the dose of spironolactone is as low as 25 mg. Thus it is essential to always monitor serum potassium.

Adult↗