lasix not given..

Nurses Medications

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Living now in rural Florida. Docs hear wont give more than 80 of Lasix a day and let Chf pts go home,. Had to go to 3 diff docs just to get lasix. Is there something i am overlooking or is this just the sticks. My client still inCHF help

Specializes in Peds, Neuro, Orthopedics.

I see you haven't answered the other poster's clinical questions about the patient and dismiss their current evidence-based knowledge. I wish you patient lots of luck. smh

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Specializes in Care Coordination, Care Management.

OP, why are you not responding to any of the questions others have asked?Several doctors have declined to increase the Lasix, you think maybe there is a reason for that?

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Specializes in Public Health, TB.

I have been a nurse for 30 years, and remember when we gave CHFers dig and Lasix and they died. Now the standard of care is neurohormonal blockade: an ACEI, carvedilol or metoprolol succinate, and spironolactone. Nitrates and digoxin may be added. Lasix may decrease acute symptoms, but there is no evidence that it prolongs life, unlike the treatment I just listed.

OP, has your client had a recent echo or right heart cath? Or labs to check electrolytes and kidney function?

These tests are often used to guide medical therapy.

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Disagree strongly with you re lasix due to extensive experience, however, the preload has been my concern. And GFR good. She works out! Maybe third spacing? There is no care here. Very backward. Have to drive 100 miles for anything decent. Nursrs here dont even know what pre load means, ARNP very slow..

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Lif I dont know what is appropriate for my patient after 35 years of nursing, THEN something is wrong. Just because some M.D. wants to polish his acedemic credentials by publishing some unfounded new theory doesnt mean i have to go along with it. Want to see a drop in BP? Give IV phenergan too fast. No, the benefits of lasix therapy outweght the negative. Stood by too mant chfers bedside for that. Brst go see max safe dose in the PDR. Dont believe every new trend that comes along.

L

In my 39 years of nursing I find that it is important to know what the patients Bun Creat, lytes, GFR and echo with note to the ejection fraction before giving any physician ordered lasix. I believe that every therapy has side effects and it is a benefit versus risk balance with every order. \

Elderly patients can be very sensitive to diuresing and can suffer from orthostatic hypotension which can lead to falls and injury to the patient. I always assess the patients B/P before giving large doses of a diuretic.

We cannot possibly know what and how much to give without assessing the patient and knowing the patients labs. What is this patients EF and history that she needs such aggressive diuresis?

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Specializes in 15 years in ICU, 22 years in PACU.
Your patient needs to 1) loose weight (I am not talking fluid weight either) 2) nitrates and ace inhibitors NOT MORE LASIX!

Feeding patients more Lasix isn't going to cure them of heart failure, but loosing weight will sure help!

Please, the word is lose not loose.

The rest of your post might be very informative but I can't get past this.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Physicians in Philly area will prescribe max dose 120mg BID. Adding Zaraxolyn or Aldactone to drug regimen is increasingly common for patients requiring high dose oral Lasix BID. Need to look at diuretic resistance too.

All our home care patients with new onset/uncontrolled CHF + COPD offered agency Telehealth program. Great success with wt, BP, O2Sat monitoring and med mgmt -- 8% rehospitalization rate.

Heart Failure Treatment & Management: Approach ...

Diuretics

Diuretics remain the cornerstone of standard therapy for acute heart failure. In such patients, IV administration of a loop diuretic (ie, furosemide, bumetanide, torsemide) is preferred initially because of potentially poor absorption of the oral form in the presence of bowel edema. In patients with hypertensive heart failure who have mild fluid retention, thiazide diuretics may be preferred because of their more persistent antihypertensive effects.[3]

Diuretics can be given by bolus or continuous infusion and in high or low doses. In a study of patients with acute decompensated heart failure, however, Felker et al found that there were no significant differences in effect on symptoms or renal function changes with furosemide given either by bolus or by continuous infusion; additionally, no differences were found with high versus low doses.[139] The dose and frequency of administration depend on the diuretic response 2-4 hours after the first dose is given. If the response is inadequate, then increasing the dose and/or increasing the frequency can help enhance diuresis.

Diuretic resistance is diagnosed if there is persistent pulmonary edema despite the following[140] :

  • Repeated doses of 80 mg of furosemide or
  • Greater than 240 mg of furosemide per day (including continuous furosemide infusion) or
  • Combined diuretic therapy (including loop diuretics with thiazide or an aldosterone antagonist)

Volume status, sodium levels, water intake, and hemodynamic status (for signs of poor perfusion) need to be reevaluated in case of diuretic resistance. Diuretic resistance is a known effect of long-term use of diuretics; some approaches to managing resistance to these agents include increasing the dose and/or frequency of the drug, restricting sodium or water intake, administering the drug as an IV bolus or IV infusion, and combining diuretics.[141, 142] In addition, diuretic resistance is an independent predictor of mortality in patients with chronic heart failure.[143] Eventually, alternative strategies, such as hemodialysis or ultrafiltration,[144] may be used to overcome it. Other agents, such as vasopressin antagonists and adenosine receptor blockers, can be used to assist diuretics.

Transition to oral diuretic therapy is made when the patient reaches a near-euvolemic state. The oral diuretic dose is usually equal to the IV dose. In most cases, 40 mg/day of furosemide is equivalent to 20 mg of torsemide and 1 mg of bumetanide. Weight, signs and symptoms, fluid balance, electrolyte levels, and renal function have to be monitored carefully on a daily basis.

Balancing Diuretic Therapy in Heart Failure - Medscape

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Specializes in Critical Care.

In all of your posts I can't find what you're basing the need for additional lasix on, maybe this is why you've had trouble convincing the Docs to up the dose.

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.
Please, the word is lose not loose.

The rest of your post might be very informative but I can't get past this.

Then don't read them, I really don't care!

Annie

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My pts didnt die. Her labs are great. Had to go to 3 diff docs for coreg......its this town.

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She wts 300 lbs. As i said, the 40 produced no urine, wheezing, severe sob. Finally admited in chf. Its this area. They are ssslow...reread all shes fine now now but like pulling teeth...

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Specializes in Family Nurse Practitioner.

For people making comments about pushing 80mg of lasix... Lasix has 2:1 PO to IV ratio. 80mg po is like 40mg IV.

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