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.

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British Journal of Clinical Pharmacology
Erasmus MC: University Medical Center Rotterdam

van der Vorst, M., Kist-Van Holthe, J., den Hartigh, J., van der Heijden, B., 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