Lasix and CRF

Aside from its loop of Henle action, Lasix also had vasodilation effects that can help decrease preload.

Yeah, what ERRN said... You were right to question (call it clarify) with the MD. A nitro drip might have been better choice but it is their license to practice as they choose. Don't forget that 50% of all MDs were in the bottom half of their class.

aaahh....ok, thanks!

Lasix is not particularly helpful in this situation. Yeas lasix works in the Loop, if I recall it acts at the Na-K-2Cl cotransporter. It will not trick dead glomeruli into working. It is also probably not harmful. Nitroglycerin is a venodilator but a person in CRF has usually lost their ability to compensate via venous capacitance so NTG would be of minimal value. Dialysis with fluid removal is the is the answer to this problem.

I work a renal floor and only pts with ARF are given lasix on our floor (if kidney function can handle the drug).. For our CRF pts they are sent to hemo to remove the fluid.

yeah, what errn said... you were right to question (call it clarify) with the md. a nitro drip might have been better choice but it is their license to practice as they choose. don't forget that 50% of all mds were in the bottom half of their class.

well, that's not half bad. i remember an older doc once shouted, "...rotating tourniquets, stat! * " at a bedside and all the rn's under the age of 50 stared at him blankly, not knowing what he was talking about, lol... damn, but i feel old

*rotating tourniquets was a method thought to mechanically drop preload, and used to treat acute pulmonary edema. it was the subject of much dispute as there was no clear research evidence that it was ever effective, with some findings in fact, suggestive that it didn't work at all. it has since fallen from favor as health care practice has shifted more towards chemical adjuncts (meds like morphine, nitroglycerin, lasix).

In addition to reducing the preload, the vasodilation effects of the Nitro paste will also dilate the pulmonary vasculature allowing some of this fluid to be pulled from the 3rd space and the subsequent Lasix will assist what little renal function is left to help excrete the fluid. In some cases, even though the patients normally do not make a lot of urine, this can cause more to be excreted. Additionally, if no urine is made, the effects of these drugs may improve oxygenation, and help to keep the patient off of BiPAP/NRB until the fluid can be removed by hemodialysis.

*I learned this after having a discussion with one of my Attendings for the same type of situation.