From the Guidelines
IV Lasix should be discontinued when the patient's fluid overload has resolved, or when adverse effects such as severe hyponatremia, acute kidney injury, or worsening hepatic encephalopathy develop, as recommended by the most recent guidelines 1.
Discontinuation Criteria
The decision to discontinue IV furosemide requires careful monitoring of the patient's condition, including:
- Clinical signs of volume overload, such as peripheral edema and breathing difficulties
- Serum electrolytes, particularly potassium and sodium levels
- Kidney function, including serum creatinine and urine output
- Daily weights to assess fluid balance
Adverse Effects
IV Lasix should be immediately stopped if the patient develops:
- Severe electrolyte abnormalities, such as hypokalemia or hyponatremia
- Acute kidney injury
- Worsening hepatic encephalopathy
- Incapacitating muscle cramps
Transition to Oral Furosemide
Transition to oral furosemide is appropriate when the patient can tolerate oral medications and their condition is stable, usually at the same daily dose divided into once or twice daily administration, as suggested by the guidelines 1.
Monitoring and Management
Regular monitoring of the patient's condition and adjustment of the diuretic regimen as needed is crucial to prevent complications and ensure optimal management of ascites, as recommended by the guidelines 1.
From the Research
Discontinuation of IV Lasix
- IV Lasix should be discontinued when patients experience severe electrolyte disturbances, such as hyponatremia, hypochloremia, alkalosis, and hypokalemia, as seen in patients with severe hypertension and moderately severe renal insufficiency 2.
- In patients with refractory congestive heart failure, IV Lasix should be discontinued if edema persists despite treatment, and severe electrolyte derangements occur 2.
- The decision to discontinue IV Lasix should be based on individual patient response and tolerance to the medication, as well as the presence of any potential untoward effects 2.
- In patients with advanced heart failure, the use of metolazone in combination with furosemide (Lasix) may be beneficial in reducing congestion and improving diuretic response, potentially allowing for the discontinuation of IV Lasix 3.
- Transitioning patients to oral diuretics, including Lasix, for ≥24 hours prior to discharge from heart failure hospitalization does not appear to improve 30-day outcomes, suggesting that IV Lasix can be discontinued and oral diuretics started prior to discharge 4.