Aim: To evaluate a high-dose continuous furosemide regimen in infants after cardiac surgery. Methods: Fifteen haemodynamically unstable infants with volume overload admitted to a paediatric intensive care unit were treated with an aggressive furosemide regimen consisting of a loading bolus (1-2 mg kg-1) followed by a continuous infusion at 0.2 mg kg-1h-1which was adjusted according to a target urine output of 4 ml kg-1h-1. Frequent sampling for furosemide concentrations in blood and urine was done for 3 days with simultaneous assessment of sodium excretion and urine output. Results: The mean furosemide dose was 0.22 (± 0.06), 0.25 (± 0.10) and 0.22 (± 0.11) mg kg-1h-1on the first, second and third day, respectively. Median urine production was 3.0 (0.6-5.3), 4.2 (1.7-6.6) and 3.9 (2.0-8.5) ml kg-1h-1, respectively, on the first, second and third day of the study. The target urine production was reached at a median time of 24 (6-60) h and this was maintained during the study period. The regimen did not result in toxic serum concentrations and was haemodynamically well tolerated. Conclusion: High-dose continuous furosemide infusion for 72 h in haemodynamically unstable infants after cardiac surgery appears to be a safe and effective treatment for volume overload. Development of tolerance against the effects of furosemide and ototoxic furosemide concentrations were not observed.

Cardiac surgery, Continuous intravenous furosemide, Infants, Tolerance, Toxicity,
British Journal of Clinical Pharmacology
Erasmus MC: University Medical Center Rotterdam

van der Vorst, M.M.J, Kist-Van Holthe, J.E, den Hartigh, J, van der Heijden, A.J, Cohen, A.F, & Burggraaf, J. (2007). Absence of tolerance and toxicity to high-dose continuous intravenous furosemide in haemodynamically unstable infants after cardiac surgery. British Journal of Clinical Pharmacology, 64(6), 796–803. doi:10.1111/j.1365-2125.2007.02913.x