Diuretic Efficacy of High Dose Furosemide in Severe Heart Failure: Bolus Injection Versus Continuous Infusion

Objectives. The efficacy of high dose furoseraide as a continuous infusion was compared with a bolus injection of equal dose in patients with severe heart failure. Background, The delivery rate of furosemide into the nephron has been proved to be a determinant of diuretic efficacy in healthy volunteers. Methods. In a randomized crossover study we compared the efficacy of a continuous infusion of high dose furosemide (mean daily dosage 690 mg, range 250 to 2,000) versus a single bolus injection of an equal dose in 20 patients with severe heart failure. The patients received an equal dosage, either as a single intrave nous bolus injection or as an 8-h continuous infusion preceded by a loading dose (20 % of total dosage). Results. Mean (±SEM) daily urinary volume (infusion 2,860 ± 240 ml, bolus 2,260 ± 150 mi, p = 0.0005) and sodium excretio