FurosemideNursing considerations

Side effects by what to assess

Sources: [1][2][3][4]

Blood glucose

Why

Hyperglycemia

When

Periodically in diabetes or suspected latent diabetes

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2]

Blood pressure

Why

Orthostatic hypotension and response

When

Carefully when combined with other antihypertensives, especially early

Normal

Below 120/80 mm Hg.

Sources: [1][2]

Body weight

Why

Fluid loss and response to diuresis

When

Daily, same time and scale

Act on

Report rapid loss or gain per orders

Potassium

Why

Hypokalemia

When

Frequently in the first few months, then periodically; more often with vomiting or IV fluids

Act on

Correct abnormalities or withhold temporarily

Normal

3.7 to 5.2 mEq/L.

Sources: [1][2]

Serum creatinine

Why

Azotemia and dehydration

When

Frequently in the first few months, then periodically

Act on

Stop if azotemia and oliguria worsen in severe renal disease

Normal

0.7 to 1.3 mg/dL in men and 0.5 to 0.95 mg/dL in women.

Sources: [1][2][3]

Sodium

Why

Hyponatremia

When

With electrolytes

Act on

Correct abnormalities or withhold temporarily

Normal

135 to 145 mEq/L.

Sources: [1][2][3]

High-alert status

Loop diuretics are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1][2]

Boxed warning

None on the current label. The oral label opens with an unboxed warning that excess doses can cause profound loss of water and electrolytes.

Sources: [1][2]

Antidote or reversal

No antidote. Overdose causes dehydration, low blood volume, hypotension, and electrolyte loss. Replace fluid and electrolytes and check electrolytes, CO2, and blood pressure often. Hemodialysis does not speed elimination.

Sources: [1]

Patient teaching

• Report thirst, dry mouth, weakness, muscle cramps, or dizziness, which can signal fluid or electrolyte loss
• Stand up slowly to avoid dizziness
• Potassium supplements or potassium-rich foods may be needed
• Blood sugar may rise; people with diabetes should watch their readings
• Skin may burn more easily in sunlight
• With hypertension, avoid OTC cold and diet products that raise blood pressure

Sources: [1][2]

Sound-alike and look-alike names

• Lasix and Luvox

Sources: [1]

Adult dose

Edema, oral

20 to 80 mg as a single dose. Repeat, or raise by 20 to 40 mg, no sooner than 6 to 8 hours later. Give the effective dose once or twice daily; up to 600 mg/day in severe edema.

Edema, IV or IM

20 to 40 mg, IV over 1 to 2 minutes. Repeat or raise by 20 mg no sooner than 2 hours later.

Acute pulmonary edema, IV

40 mg over 1 to 2 minutes. If response is poor within 1 hour, give 80 mg over 1 to 2 minutes.

Hypertension, oral

80 mg daily, usually 40 mg twice daily. Cut other antihypertensives by at least 50% when adding furosemide.

Sources: [1][2]

Renal adjustment

No fixed renal dose table. Contraindicated in anuria; stop if azotemia and oliguria worsen in severe progressive kidney disease. Ototoxicity risk is higher with severe renal impairment, so avoid rapid injection and high doses.

Sources: [1][2]

Hepatic adjustment

In cirrhosis with ascites, start in the hospital with small doses and close electrolyte checks, since rapid fluid shifts can trigger hepatic encephalopathy. Do not start during hepatic coma.

Sources: [1][2]

Mechanism

A loop diuretic. It blocks sodium and chloride reabsorption mainly in the loop of Henle, and also in the proximal and distal tubules, so more salt and water leave in the urine. Oral onset is within 1 hour, with a peak in 1 to 2 hours and effect lasting 6 to 8 hours.

Sources: [1][2]