Question regarding Lasix and Bumetanide

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Hi All, if anyone could give me any input on this it would be greatly appriciated.

Pt with CHF...excessive fluid build up, edema all over the body, has a foley in, usually OP between 250-400 each 8 hr shift. On admission orders for lasix 40mg Qday...found out quickly thats not enough. unit manager talked with MD, and he orderd Bumetanide 2.5mg po QD. I saw the order written after MD left building, as I was taking off order..I am unfamiliar with bumetanide. I know its a loop diuretic...same class as lasix right? Correct me if im wrong..? Both are potassium wasting diuretics i believe... i looked up some info in drug book and on internet...My question is MD did not order to d/c lasix. Can both diuretics be given at the same time? Im concerned about the risk for hypokalemia... The med was ordered friday evening, pharmacy should be sending medication late this evening and pt should get first dose by me at 9am tomorrow. I put a call in to MD today to ask about it, and did not recieve a call back. Am i being over cautious? Could anyone give me any insight....Thanks a bunch! :nurse:

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Both are sometimes prescribed together. You can ALWAYS call you facility pharmacy and speak with the pharmacist about med questions. When I am not sure I prefer to call the pharmacist BEFORE clarifying the order with the MD. I hate getting yelled at by doc's! Also, where is the potassium supplement? Does the pt have an order for KCL to replace the lost potassium with the diuretics? You definitely should follow up with MD on that...good luck!

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Thanks! I dont know why, but the pharmacy ALWAYS slips my mind. I guess its just not a habit for me. Perhaps I should make it a habit. I will certianly call them in the AM though just to clarify! And no, no orders for potassium supplements...I will be getting on that too. Thanks for your reply!

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Specializes in Cardiac Telemetry, ED.

Yes, you can give them both, but you need to monitor serum potassium.

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iv lasix and po butamide are not given together at my hospital but po both are fine.

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You'd think one of the two would be a potassium sparing diuretic. I would also want to have ability to check potassium and have something available if needed since you have to wait for stuff.

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Both can be given together IV or PO. They are both loops, but act in synergy. Is the patient in renal failure, many times there is a worry of hyperkalemia. He should have ordered a bolus dose of bumex IV before routine therapy. :confused:

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ask for potassium protocol orders :)

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

luvnlpn08 (op) works in a skilled nursing facility(snf) so med mangement different than hospital care.

a. does the patient have recent blood work basic metabolic panel that would show bun, creatine and potassitum level? if not done within the pst 2-4 weeks, docotr might wnat to add that as a baseline to make med adjustments if renal failure suspected vs just chf might not need potassisum supplement. usually do not see both lasix and bumetanide = bumex in snf facility.

b. since patient was only on lasix 40 mg (low dose.....i've many homecare chf patients on lasix 80mg bid), bumex 2.5 mg = lasix 100mg. please clarify this order with dr in am.....highly suspect he wanted lasix d'cd and bumex used in it's place.

[color=#2200cc]bumetanide dosing

to convert a lasix dosage to a bumetanide dosage, divide the lasix dose by 40 (because bumetanide is 40 times more potent than lasix

http://congestive-heart-failure.emedtv.com/

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